Background: Spine procedures is linked to a significant risk of bleeding and blood transfusions, which can result in poor vision during procedure and adverse clinical results. Several pharmacological medications can be utilized to minimize blood loss and enhance operative field visibility during spine procedures, according to earlier research. We aimed to improve quality of surgical field by employing intravenous tranexamic acid or dexmedetomidine to reduce blood loss in patients having spine procedures.

Methods: This prospective randomized double-blind control clinical study was conducted at Anesthesia, Intensive Care and Pain management Department, Faculty of Medicine, Zagazig University Hospitals on 78 patients who underwent lumbar decompression and fixation surgery at 2 levels. They were divided into: control group, tranexamic acid group and dexmedetomidine group. Primary outcome is the effect of tranexamic acid and dexmedetomidine on improving surgical field quality, while secondary outcome is the effect of tranexamic acid and dexmedetomidine on hemodynamics, and their side effects.

Results: Tranexamic acid had the upper hand in decreasing the amount of blood loss and blood transfusion than other drugs, while dexmedetomidine achieved more hypotensive and bradycardiac effects. Side effects were more in dexmedetomidine group than other groups, represented mainly as hypotension and bradycardia. Duration of surgery was shorter in tranexamic acid group than other groups. Emergence and discharge times were longer in dexmedetomidine group than other groups.

Conclusion: In spine surgeries, tranexamic acid and dexmedetomidine were more effective than control group in decreasing blood loss and blood transfusion with superiority of tranexamic acid than dexmedetomidine.