Effect of topical and systemic tranexamic acid on bleeding and quality of surgical field during ear exploration surgery : adouble-blind, randomised clinical trial

Abstract EN

Background The surgical field during microscopic ear surgery is small and needs specific anesthetic considerations to improve the surgical field quality and control the bleeding during ear surgery, as little amount of bleeding can impair the quality of the surgical field and the surgical outcome.

This can be achieved by different methods, which carry specific risks, such as hypotensive anesthesia, and use of local vasoconstrictors, which are associated with cardiac and hemodynamic risks.

The objective of this study was to assess the effect of tranexamic acid (TXA) topically and systemically on bleeding and quality of surgical field during ear exploration surgery.

Materials and methods A total of 90 patients undergoing ear exploration surgery were randomly divided into three group.

Group A included 30 patients who received systemic TXA in a dose of 10–15 mg intravenous over 30 min, followed by infusion in a dose of 1 mg/kg/h throughout surgery.

Group B included 30 patients who received topical TXA in dilution of 1 g diluted in 200 ml saline for surgical wash and soaking the used gauze for compression on the bleeding site.

Group C included 30 patients who received diluted adrenaline 1 mg diluted in 200 ml saline used for surgical wash and soaking gauze used for compression of the bleeding site, and this was considered as a control group.

Assessment parameters included intraoperative blood loss, quality of surgical field using Boezaart grading with 0–5 scores, hemodynamics and perioperative adverse effects.

Results There were no significant differences between groups in the demographic and clinical characteristics regarding age, sex, weight, and height and in anesthesia time, surgical time or time of recovery.

The quality of the surgical field was better in group B than groups A and C.

The intraoperative bleeding was significantly reduced in group B more than groups A and C, and postoperative nausea, vomiting and blurring of vision were more in group A than the other groups.

Conclusion Topical application of TXA has a more significant effect on reducing bleeding and improving the quality of the surgical field during ear exploration surgery with nonsignificant adverse effects.