Effect Of Topical Tranexamic Acid(TA) On Early Postoperative Pain After Total Hip Arthroplasty (THA): A Prospective Randomized Study With Short-term Follow-up

1.Background The use of tranexamic acid(TA)after total hip arthroplasty has been effective in reducing blood loss due to surgical trauma.However,it has been suggested that tranexamic acid use may increase postoperative pain.In addition,there are reports that tranexamic acid may reduce postoperative pain.There are,of course,a few studies that show no effect of tranexamic acid use on postoperative pain.Therefore,although the use of tranexamic acid may reduce postoperative blood loss,the effect on postoperative pain and related inflammatory parameters remains inconclusive.The purpose of this study was to evaluate the effect of tranexamic acid on pain and pain-related inflammatory factors in the early postoperative period after total hip arthroplasty,and to assess the effect on postoperative blood loss.2.MethodsPatients who underwent first unilateral total hip arthroplasty at our hospital from06/2021 to 12/2022 done by the same surgeon were prospectively included and screened by exclusion and inclusion criteria,and patients eligible for the study were randomized by means of an envelope(the envelope contained both use and non-use notes,and the same person randomly grabbed one of the notes and coded the patients into two groups according to the note wording)into Tranexamic acid topical use group(TP group: n=44)and tranexamic acid non-topical use group(NON-TP group:n=35).A modified Hardinge approach was used for all patients,and lumbar anesthesia(with the same dose)was used for all patients.After surgery,a drainage tube was placed in both groups,and 50 ml of tranexamic acid was injected into the joint through the drainage tube in the TP group(no tranexamic acid was injected in the NON-TP group),and the drainage tube was clamped for 2 hours.Preoperative demographic characteristics,preoperative diagnosis,and laboratory test indexes were collected from both groups.The study indexes were(1)The visual analog scale(VAS)was used to assess patients’ postoperative resting pain and changes in pain-related inflammatory factors(e.g.,C-reactive protein,interleukin 6,erythrocyte sedimentation rate,calcitoninogen,neutrophils,leukocytes,and lymphocytes).(2)Pre-and post-operative hematocrit(HCT)was collected from patients,and blood loss was calculated using the formula to assess the effect of topical tranexamic acid application on post-operative blood loss3.ResultsVas scores for both groups from postoperative day 1 to day 5,TP group(3.09,2.83,2.88,2.36,1.82)and NON-TP group(3.35,2.97,2.85,2.49,1.96)showed an overall decreasing trend over time in both groups,but there was no statistical difference(p >0.05);postoperative day 2 day TP group and NON-TP group pain-related inflammatory indexes(IL-6: 9.84,7.68;ESR: 30.63,36.70;PCT: 0.11,0.12;CRP:73.20,66.35;WBC: 8.59,8.38;NEUT: 6.47,6.90;LYM: 1.00,0.94),the two groups did not There was no statistical difference between the two groups(P > 0.05);pain inflammation indexes in the TP group and NON-TP group on postoperative day 5(IL-6: 8.13,8.32;ESR: 34.90,42.08;PCT: 0.10,0.11;CRP: 35.40,30.36;WBC: 6.31,6.10;NEUT: 4.54,4.76;LYM : 1.14,1.04),there was also no statistical difference between the two groups(P > 0.05).There was no statistical difference(P > 0.05)between the two groups in terms of apparent blood loss,on postoperative day 2(TP group: 292.38 ml;NON-TP group: 305.00 ml)and postoperative day 5(TP group:292.86 ml;NON-TP group: 307.57 ml);total blood loss and invisible blood loss were calculated by HCT values on postoperative day 2,TP group(514.24 ml,221.86 ml)and the NON-TP group(908.14 ml,598.54 ml),there was a statistically significant difference between the two groups(P < 0.05),and the total blood loss and invisible blood loss calculated by the HCT value on the 5th postoperative day,the TP group(599.40 ml,306.54 ml)was statistically different from the NON-TP group(880.18 ml,572.62 ml)had less blood loss,but there was no statistical difference between the two groups(P > 0.05).4.ConclusionsTopical tranexamic acid had no significant effect on pain as well as pain-related inflammatory factors in the early postoperative period(postoperative day 1 to day 5)after total hip arthroplasty;topical tranexamic acid had a significant effect on the reduction of blood loss in patients on postoperative day 2 after total hip arthroplasty,which helped to reduce postoperative blood loss;on postoperative day 5,although the TP group lost less blood than the NON-TP group,the effect was not significant.