TRANEXAMIC ACID ADMINISTRATION IN ARTHROSCOPIC SURGERY IS A SAFE ADJUNCT TO DECREASE POSTOPERATIVE PAIN AND SWELLING: A SYSTEMATIC REVIEW META-ANALYSIS

摘要

Summary This is a systematic review and meta-analysis of the effects of tranexamic acid (TXA) in arthroscopic surgery that suggests TXA improves pain scores and visual clarity/technical ease, and also decreases drainage output, need for joint aspirations, and incidence of hemarthrosis, without an increase in complications. Data Background Tranexamic acid (TXA) has been used effectively to decrease blood loss in many fields of surgery. Guidelines for use in arthroscopic surgery are limited to date. Purpose To systematically screen the literature in an effort to critically examine the effect of TXA in patients undergoing arthroscopic surgery, specifically pertaining to pain, blood loss, length of surgery, and both major and minor complications. Study Design: Systematic Review and Meta-Analysis Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) guidelines, three databases (MEDLINE, EMBASE, and Cochrane) were searched April 2020 and screened in duplicate using inclusion and exclusion criteria for studies on the given subject. Study findings were reviewed, and meta-analysis was then performed on sufficiently congruent data using a random-effects model. Results There were seven eligible randomized controlled trials, with 724 total patients, undergoing ACL reconstruction (4 studies, 537 patients), meniscectomy (1 study, 45 patients), femoroacetabular impingement (1 study, 70 patients), or rotator cuff repair (1 study, 72 patients). The mean age throughout the included studies was 33.9 years, with a mean of 27.7% female patients. There was a 1% drop out rate at 3 months postoperatively. There were significantly lower VAS scores at 2 weeks postoperatively in the TXA groups (Mean difference: -1.65, 95% CI = -3.41 to 0.10, P = 0.06, I 2 =97%). Furthermore, there was a significant decrease in the number of patients requiring joint aspiration in the TXA groups (Risk Ratio= 0.27, 95% CI= 0.12 to 0.56, I 2 =0%, p = 0.0006). The drainage output in TXA groups was also significantly decreased (Mean difference: —61.14ml, 95% CI = -104.43 to -17.85, I 2 =94%, p = 0.006).