Intravenous Administration of Tranexamic Acid Significantly Improved Clarity of the Visual Field in Arthroscopic Shoulder Surgery. A Prospective, Double-Blind, and Randomized Controlled Trial

Liu, Yuan-Fu; Hong, Chih-Kai; Hsu, Kai-Lan; Kuan, Fa Chuan; Chen, Yueh; Yeh, Ming Long; Su, Wei

doi:10.1016/j.arthro.2019.10.020

Cited by 52 publications

(79 citation statements)

References 23 publications

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“…[8,9,11] Although systemic administration of TXA has been found to be effective in obtaining better vision in shoulder arthroscopy, little is known about the impact of local administration of TXA on the surgeon's visualization during arthroscopic operations, and no study has yet investigated whether TXA is superior to EPN in providing visual clarity during arthroscopic rotator cuff repair. [10] Therefore, the primary endpoint of the present study was the comparative results of adding TXA or EPN to the irrigation fluid for visual clarity.…”

Section: Discussionmentioning

confidence: 99%

“…bleeding during shoulder and knee replacement surgery, [8,9] improving visual clarity in arthroscopic shoulder surgery, [10] and reducing hemarthrosis following the arthroscopic anterior cruciate ligament reconstruction. [11] Nonetheless, to the best of our knowledge, no study has investigated the effect of TXA versus EPN yet, when used in irrigation solution on visual clarity during arthroscopic rotator cuff repair.…”

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confidence: 99%

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Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Bayram

2021

Jt Dis Relat Surg

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Over the past decade, arthroscopic repair has been recognized as an important treatment option for rotator cuff tears. Sufficient visualization is of paramount importance for the arthroscopic repair to be efficiently and effectively performed. Intra-articular bleeding is one of the main factors which compromises the visual clarity in arthroscopic procedures. [1,2] Therefore, several hemostatic techniques, including hypotensive anesthesia, electrocauterization, and use of pressure-or flow-controlled pumps, are utilized to prevent intraoperative bleeding and to obtain sufficient visualization during the arthroscopic surgical procedures. [3][4][5] Recently, a number of clinical trials have supported the use of irrigation fluid with Objectives: This study aims to investigate whether there was a difference between epinephrine (EPN) and tranexamic acid (TXA) in providing visual clarity during arthroscopic rotator cuff tear repair.Patients and methods: This double-blind, prospective, randomized-controlled clinical study included a total of 90 patients (42 males, 48 females; mean age: 55.6±8.3 years; range, 18 to 69 years) in whom either EPN (EPN group, n=47) or TXA-diluted irrigation solutions (TXA group, n=43) were used during rotator cuff tear arthroscopy between December 2017 and November 2019. Arthroscopy was performed using irrigation fluid containing 0.33 mg of EPN per 1 L of saline in the EPN group and 0.42 mg of TXA per 1 L of saline in the TXA group. All procedures were performed by two specialized shoulder surgeons. Visual clarity (primary endpoint) was rated by the operating surgeon using the Visual Analog Scale (VAS) in the immediate postoperative period. Secondary endpoints included total operating time (TOT), potential thrombotic or thromboembolic side effects, mean arterial pressure (MAP), and total amount of irrigation fluid used.Results: There was no significant difference in the surgeon rated-VAS scores between the groups. The mean VAS score was 7.6±1.62 (range, 4 to 10) in the EPN group and 7.1±1.74 (range, 3 to 10) in the TXA group (p=0.59). No cardiac, thrombotic, or thromboembolic complications were observed in any of the groups. Conclusion:Adding TXA to the irrigation fluid during the arthroscopic rotator cuff repair may provide similar visual quality to the EPN, as measured by VAS.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Bayram

2021

Jt Dis Relat Surg

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“…18 Furthermore, the use of IV TXA in shoulder arthroscopy for rotator cuff repair has resulted in reduced postoperative pain levels and analgesic use in addition to improvements in surgeons' subjective visual clarity scores. 23 Additionally, Yang et al 31 demonstrated that the use of IV TXA in spinal surgery resulted in significant reductions of blood loss and fewer blood transfusions without risk of DVT or thromboembolic events compared to control.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Use in Foot and Ankle Surgery

Johns

Walley

Seedat

et al. 2020

Foot & Ankle Orthopaedics

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Background: There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery. Methods: A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months. Results: Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics ( P > .05) and traumatic and nontraumatic cases ( P > .05). Conclusions: The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised. Level of Evidence: Level IV, case series.

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“…Tourniquet has been widely used in arthroscopic surgery to reduce intraoperative bleeding and improved operative eld visibility, which potentially reduces operative time [18][19]. However, recently, with the increase of the ow of irrigation uid, local or systemic application of tranexamic acid, or adding epinephrine to the irrigation solution, achieving a satisfactory visualization without having to in ate the tourniquet is possible [18,20]. Also, a recent systematic review and meta-analysis of randomized controlled trials had provided evidence that arthroscopic surgery without tourniquet does not appear to prolong operative time [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Tourniquet Use in Ankle Arthroscopic Surgery on Postoperative Recovery: A Prospective Non- Randomized Controlled Study

Huang

Liu

et al. 2020

Preprint

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The aim of this prospective non- randomized controlled study was to explore the effect of tourniquet use on joint swelling, pain, functional outcome, and tourniquet- related ischemia- reperfusion injury (IRI) during ankle arthroscopic surgery.52 patients who received ankle arthroscopy were allocated to had the procedure done with the tourniquet inflated (the Control group, n= 27) or without the tourniquet inflated (the NT group, n= 25). The main outcome measures were: (1) The amount of swelling of the ankle; (2) Pain as measured by a visual analog scale (VAS); (3) The levels of MDA, IMA,TOS, TAS and OSI at 10 min before incision (T1)，after the completion of surgery (T2), and 30 min after tourniquet deflation (T3); (4) The functional outcome as measured by American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score; (5) The rate of complication. All patients were reviewed at a mean follow- up of 14.2 months (range, 12- 19 months). The mean circumferences of the ankle in the NT group were significantly lower than those in the Control group on postoperative day 2 and 5 (p<0.05). The mean level of VAS in the Control group was significantly higher on postoperative day 2 (p<0.05). The outcomes of AOFAS ankle hindfoot score were comparable between groups postoperatively (p>0.05). The levels of MDA, IMA, TOS and OSI were all significantly lower in the NT group compared at T2 and T3 (p<0.05), and the level of TAS was significantly lower in the NT group at T3 (p<0.05). The complication rates of two groups were comparable (p>0.05).With the use of tourniquet during ankle arthroscopic surgery, there was increased joint swelling and pain postoperatively, and a trend toward increased levels of MDA, IMA, TOS, TAS and OSI intraoperatively. Thus, we do not recommend using a tourniquet in this type of procedure.

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Intravenous Administration of Tranexamic Acid Significantly Improved Clarity of the Visual Field in Arthroscopic Shoulder Surgery. A Prospective, Double-Blind, and Randomized Controlled Trial

Cited by 52 publications

References 23 publications

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Tranexamic Acid Use in Foot and Ankle Surgery

Effect of Tourniquet Use in Ankle Arthroscopic Surgery on Postoperative Recovery: A Prospective Non- Randomized Controlled Study

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