Topical tranexamic acid tied to reduced opioid consumption after Total hip arthroplasty

They conducted a prospective randomized controlled study.

The important study points are:

• There were 161 patients divided into two groups: topical group and intravenous group.
• The topical group had 79 patients, and the intravenous group had 82 patients.
• VAS or visual analogue scale assessed hip pain within three days after surgery.
• Tramadol was used for pain relief when necessary.
• Hematologic tests were used to assess Inflammatory markers like high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and haemoglobin drop.
• The primary outcomes measured were the VAS score and tramadol dose from the first to the third day after surgery.
• The secondary outcomes measured were the Inflammatory markers level, total blood loss and complications.

Explaining study results, they said pain score and inflammation markers level on the first day in the topical TXA group (2 g of TXA mixed in 50 ml normal saline injected in the drainage tube after closing the incision, keeping it closed for three h ) were lower compared to intravenous TXA group. The VAS score on the first day after surgery had a positive correlation with the inflammation markers. The dose of tramadol was lower compared to the intravenous group on the first and second days after surgery.

No differences were reported in total blood loss between the two groups and incidence of complications, they said.

The study's strength includes prospective randomized controlled trials and comprehensive assessments.

Further reading:

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06576-7