The Use of Intravenous Tranexamic Acid Does Not Improve Athroscopic Visualisation in Shoulder Surgery: A Randomised Control Trial

Description

In this presentation, Jason Old discusses a study examining the intravenous use of Tranexamic Acid (TXA) compared to epinephrine in improving visualization during shoulder arthroscopy. He begins by highlighting the importance of visual clarity in performing surgeries safely and effectively, noting the traditional use of epinephrine to achieve better clarity but indicating potential cardiac side effects associated with it. With the objective of confirming whether intravenous TXA is a safer alternative, Old elaborates on the study's design: a double-blinded randomized controlled trial including 128 patients undergoing arthroscopic shoulder procedures with a subacromial component, focusing on visual clarity as the primary outcome.



The methodology involved four randomized groups: one receiving epinephrine, another receiving TXA intravenously before surgery, a third group receiving both agents, and a control group with neither. Visual clarity was assessed every 15 minutes during the surgery using a four-point Likert scale by blinded surgeons. Results revealed that epinephrine enhanced visual clarity, while TXA did not provide significant benefits. Factors like longer surgical duration and lower mean arterial pressure negatively affected visualization.



While the study's outcome was significant, Old addressed limitations such as the subjective nature of the primary outcome and the variability introduced by multiple observers rating the visual clarity. He concluded by emphasizing the findings and acknowledging the support received for the research.

DOI: 10.1302/3114-222004

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