Evaluation of Intravenous Tranexamic Acid on Bleeding and Quality of surgical Field in Functional Endoscopic sinus Surgery

Bleeding during functional endoscopic sinus surgery (FESS) remains a challenge for both surgeons and anesthesiologists despite several modalities available for improving the surgical field. In spite of demonstrated favorable effects of tranexamic acid (TA) on bleeding tendency in cardiac, major orthopedic, transplantation and prostate surgeries, its IV use in FESS has never been examined. This study was conducted to evaluate the efficacy of intravenous TA in improving the surgical field in FESS. In placebo-controlled clinical trial a total of 84 ASA physical status I-II patients, aged 14–64 years, undergoing endoscopic sinus surgery under generalanaesthesia were randomly allocated to receive either intravenous TA 10 mg/kg or sterile water 0.1cc/kg as a bolus dose immediately after induction of anesthesia. Anesthesia and surgery protocols were the same in both groups. Bleeding and satisfaction scores were obtained from the surgeon and his aid and compared between two groups. In view of the surgeon, the median (range) bleeding score in the TA group was significantly lower than placebo group [2 (1-3) vs. 2.5 (2-4), p<0.0001]. Accordingly, the surgeon was more satisfied with the surgical field in the TA group than placebo group (median score, 4 (3-5) vs. 3 (1-5), p<0.001). The viewpoints of surgeon and his aid regarding the bleeding and satisfaction scores were acceptably correlated (r=0.82 and r=0.84, respectively; p<0.001). Intravenous TA can effectively reduce bleeding during FESS.