EFFECT ON THE SURGICAL FIELD QUALITY DURING FUNCTIONAL ENDOSCOPIC SINUS SURGERY BY USE OF INTRAVENOUS AND TOPICAL TRANEXAMIC ACID

Abstract

Background: The patients had trauma or hemorrhage condition, tranexamic acid (TXA) has been shown to decrease mortality. Intraoperative bleed is one of the major challenge a surgeon encounters during FESS. The purpose of this research is to study the effect of local or intravenous tranexamic acid on surgical field quality and about need for transfusions.

Objective: The objective of this study was to evaluate and compare the effects of topical and intravenous tranexamic acid (TXA) administration on surgical field quality, intraoperative blood loss, and the need for transfusions during functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis.

Methods: Seventy people with chronic sinusitis participated in the prospective observational research, which was carried out at department of ENT and Combined Military Hospital Rawalpindi. Thirty-five patients in the one group administrated with intravenous TXA and thirty-five received topical TXA before surgery. Boezaart grading system was used to assess the quantity of blood loss and quality of the operative field at fifteen, thirty and forty-five minutes during surgery.

Results: In all, there were 31 male patients and 39 female patients. The patients' ages ranged from 50.97±10.97 years and 52.47±10.48 years enrolled in intravenous and topical TXA administration groups. After 45 minutes after the start of surgery, most patients in the intravenous group (17.1%) were in grade II, whereas only 2.9% of those in the topical TXA group were at that point. Furthermore, there was considerably less bleeding in the topical group compared to the intravenous group across all time points studied (P = 0.00). The postoperative timings are statistically significant between intravenous and topical TXA groups (p<0.05). 

Conclusion: The use of topical TXA prior to FESS in patients with rhinosinusitis significantly decreases blood loss and enhances visibility in the sinus cavity. These findings suggest that within 30 minutes of administration, topical TXA may help create a good surgical field.