Efficacy of Tranexamic Acid in reducing intra-operative bleeding during tonsillectomy

Abstract

Background: Our study aims to determine the effectiveness of tranexamic acid in decreasing the intraoperative blood loss during tonsillectomy.
 Materials and Methods: Study design was randomized double-blind control trial. This study was conducted from 1 November 2017 till 30 June 2019 in the department of ENT unit-II, the civil sandeman provincial teaching hospital Quetta. Ethical approval was taken from Ethical Review Board of the civil Sandeman provincial teaching hospital Quetta. A sample of 100 patients were surveyed, 55 men and 45 woman, 10-30 year age range, 1.2:1 men to female with a mean 20 year age. Patients who met the criteria for inclusion experiencing an elective tonsillectomy were randomly assigned to two groups. Every community has equivalent patients. An injection of 10 mg/kg body weight was given intravenously into group-A 5-10 minutes prior to surgery, and normal saline of the same amount was administered intravenously into group-B. Intraoperative bleeding was measured at Operation Theatre in both groups during surgery. In intraoperative blood loss, the effectiveness of tranexamic acid / placebo was determined by measuring loss of blood computed by Gravimetric method and blood obtained in suction jar by measuring.
 Results: In Group-A and Group-B patients, there was a significant difference in intra-operative loss of blood during tonsillectomy. In group A, intra-operatively, there was overall blood loss of 1404 ml and the average blood loss was 33ml. During surgery in group-B the blood loss was 3132 ml, and the average loss of blood was 62-64ml. As a result, group B was more intraoperative bleeding and consumed more time compared to group A.
 Conclusion: Study group patients receiving preoperative intravenous tranexamic acid have less intraoperative loss of blood and less time consuming than placebo patients who have not obtained tranexamic acid intravenous.

A systematic review on the efficacy of tranexamic acid in head and neck surgery

“…[23][24][25]30 Santosh et al 23 reported a mean reduction of 40.72 mL in their study group while George et al 24 reported a reduction of 29.68 mL. Achakzai et al 30 similarly reported a reduction of 29.59 mL in their study group. Pukhlik et al 29 reported a much lower reduction at 19 mL.…”

“…[23][24][25]29,30 Four out of these five studies reported significant reduction in the volume of intraoperative blood loss. [23][24][25]30 Santosh et al 23 reported a mean reduction of 40.72 mL in their study group while George et al 24 reported a reduction of 29.68 mL. Achakzai et al 30 similarly reported a reduction of 29.59 mL in their study group.…”

“…into two main categories-8 out of the 16 studies were identified to be major H&N surgical studies [6][7][8][18][19][20][21][22] while the other 8 were tonsillectomy studies. [23][24][25][26][27][28][29][30] The characteristics of the studies for the tonsillectomy studies are defined in Table 4 and for the H&N studies in Table 5, including a breakdown of the type of H&N operations undertaken. There were 941 patients in the H&N studies and there 113 466 patients in the tonsillectomy studies.…”

“…Significant reductions in intraoperative blood loss were found with the use of TXA in tonsillectomy patients. [23][24][25]29,30 Since the overall intraoperative blood loss is minimal during tonsillectomy, 37 the therapeutic importance of these reductions is debatable. Moreover, two of the tonsillectomy studies 24,25 investigated the impact on the duration of the surgery and both reported clinically significant reductions.…”

The efficacy of Tranexamic Acid Administration in Patients Undergoing Tonsillectomy: An Updated Meta-Analysis

“…Based on the NOS, all non-randomized studies 17,18,20,22,23,26 received a score between 6 and 8, indicating that they had fair methodological quality (Table 4). Most of the RCTs 19,21,24,25 had a low risk of bias (Figure 2), except for the study conducted by Castelli and Vogt 25 due to poor blinding of participants and personnel.…”