Application of tranexamic acid in shoulder arthroscopic surgery

Background: Bleeding during arthroscopic shoulder surgery decreases visual clarity. Tranexamic acid is widely used to decrease bleeding in orthopedic surgery. But the application of tranexamic acid in arthroscopic shoulder surgery is limited. The purpose of this study is to explore the best administration route of tranexamic acid during arthroscopic shoulder surgery. Methods A total of 134 patients who underwent arthroscopic rotator cuff repair surgery were randomly assigned to 4 groups: control group, intravenous group, irrigation group, intravenous and irrigation group. The patients in intravenous group was given tranexamic acid intravenously 10 minutes before surgery, in irrigation group tranexamic acid was added into the irrigation fluid during subacromial decompression and acromioplasty procedure, For intravenous and irrigation group tranexamic acid was applied both intravenously and in intra-articular irrigation. The primary outcome was the visual clarity, the secondary outcomes includes irrigation fluid consumption and time of subacromial decompression and acromioplasty procedure of the surgery. Result All 3 intervention groups got higher visual analog scale than control group. Intravenous and irrigation group got better visual analog scale than intravenous group and irrigation group. Control group consumed more irrigation fluid during subacromial decompression and acromioplasty procedure than the other 3 groups. Intravenous and irrigation group consumed less irrigation fluid during subacromial decompression and acromioplasty procedure than intravenous group and irrigation group. There was no difference in subacromial decompression and acromioplasty procedure time between all the 4 groups. Conclusions: tranexamic acid applied both intravenously and intra-articular enhanced visual clarity, combined intravenous and intra-articular tranexamic acid reached the best visual clarity. Conclusion Tranexamic acid applied both topically and systematically enhance intraoperative visual clarity, Combined application achieves the best effect.