Topical tranexamic acid may be an effective adjunctive analgesic post hip arthroplasty
1. In this prospective randomized controlled study, pain scores for the topical tranexamic acid (TXA) group on the first day after total hip arthroplasty (THA) were significantly lower than the intravenous (IV) group.
2. Those enlisted to receive topical TXA were additionally observed to use lesser amounts of tramadol on days 1 and 2 postoperatively.
3. There was no significant difference in total blood loss or adverse events between the two groups.
Evidence Rating Level: 1 (Excellent)
The possibility of opioid dependence post-operatively should always be a consideration for healthcare providers. Of particular concern is the rate of opioid dependence following total hip arthroplasties. Thus, control of postoperative pain should be of importance. While perioperative TXA has been widely studied in the context of blood loss prevention, few studies have elucidated its effects on early postoperative pain. To further investigate this, researchers conducted a prospective randomized controlled study in which patients undergoing THA were divided into either a topical TXA group (n = 79) or an intravenous group (n = 82), administered perioperatively. Visual analogue scale (VAS) scores were used to assess postoperative pain at one, two, and three days post-THA. On the first day after surgery, the topical TXA group had significantly lower hip pain scores (3.54 ± 0.46 vs. 3.84 ± 0.39, p <0.001), CRP, IL-6, and ESR levels (Ps ≤ 0.001). These differences were no longer statistically significant on days 2 and 3 post-THA (Ps ≥ 0.05). The doses of tramadol used differed significantly between the two groups on postoperative days 1 and 2 (P = 0.037 and P = 0.039, respectively), but not on day 3. With respect to blood loss, there were no significant differences in hemoglobin levels (12.22 ± 4.05 g/L vs. 17.07 ± 4.04 g/L, P = 0.824) or calculated blood loss (640.60 ± 188.12 ml vs. 634.20 ± 187.85 ml, P = 0.827) between the two groups. There was also no significant difference in the rate of postoperative complications between the groups. Overall, this study demonstrates that overall opioid consumption in the early stages after THA may be decreased with the use of topical TXA perioperatively. It also demonstrated that TXA could potentially affect the local inflammatory response on the first day after surgery. Additional studies into the effects of topical TXA perioperatively should be conducted to further this hypothesis.
Click to read the study in BMC Musculoskeletal Disorders
Image: PD
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