Preoperative Systemic Tranexamic Acid in Tonsillectomy and Adeno-tonsillectomy: A Relevant Underrated Outcome

Abstract

Introduction Tranexamic acid, a synthetic anti-fibrinolytic plasminogen inhibitor, a relatively safe drug, is reported to reduce bleeding in various surgical procedures. Our study was to identify the efficacy of tranexamic acid in reducing intraoperative bleeding during tonsillectomy and adeno-tonsillectomy, a common paediatric ENT surgery done as day care procedure. Materials and Methods A randomised, placebo controlled, double blinded trial was undertaken with consecutive patients undergoing above procedures, sample size being 100, with 50 patients in each arm. Post induction, injection tranexamic acid 15mg /kg body weight and saline was given to the test and control group respectively. Intraoperative bleeding was measured and operating time was also noted. Results There were 80 participants, with 41 and 39 patients in treatment and placebo group respectively ranging from 4 to 32 years age. There was no significant difference in the amount of blood loss between the two groups. However, the duration of surgery was significantly lowered in tranexamic acid as compared to placebo group (p = 0.008). Conclusions Preoperative use of tranexamic acid in tonsillectomy or adeno-tonsillectomy, significantly reduced operating time though no significant reduction of intra or postoperative bleeding was noted. This previously unreported outcome has surgical implication, especially in children, for possible use of this widely accepted safe drug during these procedures.

Keywords

• Adenoidectomy
• Tonsillectomy
• Haemorrhage
• Tranexamic Acid
• Operative Time