Abstract
BackgroundThe effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet. This study was conducted to answer this question.MethodsThis trial was conducted on 60 patients with chronic sinusitis at Beasat Hospital, Hamadan, Iran, from April to November 2013. Thirty patients in the intervention group received three pledgets soaked with TXA 5% and phenylephrine 0.5% for 10 minutes in each nasal cavity before surgery. Thirty patients in the control group received phenylephrine 0.5% with the same way. The amount of bleeding and the quality of surgical field were evaluated at 15, 30, and 45 minutes after the start of surgery using Boezaart grading.ResultsThe quality of the surgical field in the intervention group compared to the control group was significantly better in the first quarter (P = 0.002) and the second quarter (P = 0.003) but not in the third quarter (P = 0.163). Furthermore, the amount of bleeding was much less during all periods in the intervention group than in the control group (P = 0.001).ConclusionTopical TXA can efficiently reduce bleeding and improve the surgical field in FESS in patients with rhinosinusitis. Based on these findings, topical TXA may be a useful method for providing a suitable surgical field during the first 30 minutes after use.Trial RegistrationIranian Registry of Clinical Trials IRCT201212139014N15
Highlights
Bleeding during endoscopic sinus surgery is still a challenge for surgeons and anesthesiologists [1]
The eligible patients with chronic sinusitis with or without polyposis who referred to Ear-Nose-Throat clinic of Beasat Hospital were enrolled if they had the following criteria: (a) being candidate for functional endoscopic sinus surgery (FESS) based on AAO-HNS criteria [22]; (b) age of 18 to 60 years; (c) hemoglobin .10 mg/dl; (d) normal clotting time (CT), bleeding time (BT), international normalized ratio (INR), prothrombin time (PT), Partial thromboplastin time (PTT)
Patients, of whom 30 patients were randomly allocated to the intervention group (TXA plus phenylephrine) and 30 patients to the control group
Summary
Bleeding during endoscopic sinus surgery is still a challenge for surgeons and anesthesiologists [1]. Many techniques have been proposed to improve the field of functional endoscopic sinus surgery (FESS). Diathermy can lead to local mucosal damage and delayed bleeding [3]. Induction hypotension exposes the patients to more anesthetic drugs and a higher risk of potential side effects. Neither of these methods guarantees a desirable surgical field with no bleeding. Investigators are working on more effective and safer methods to reduce bleeding and to improve the field of endoscopic sinus surgery [7]. The effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet.
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