Abstract
Objectives:
Tranexamic acid (TXA) is an anti-fibrinolytic agent that has been effective in reducing transfusion risk and minimizing blood loss after total joint arthroplasty. Interest has grown to use TXA in sports medicine procedures, particularly shoulder and knee arthroscopy, to reduce hemarthrosis and improve arthroscopic visualization. TXA use has had mixed results on postoperative pain after arthroscopic rotator cuff repair (ARCR) but lower opioid consumption was demonstrated after ARCR during the first 24 hours in an inpatient setting. The purpose of this study was to examine the impact of TXA on opioid consumption in an outpatient setting after ARCR.
Methods:
Patients scheduled to have ARCR with one surgeon at one institution were eligible for inclusion. This was a prospective, double-blind, randomized and placebo-controlled study comparing TXA administration of 1,000 mg IV to an equivalent volume of IV saline. The primary outcome was opioid consumption as measured by morphine milligram equivalents (MME) for the first three days postoperatively. Secondary outcomes were subjective measurement of pain as measured by VAS for the first three days postoperatively.
Results:
164 patients were enrolled, with 82 patients in each group (TXA or placebo). The groups did not differ significantly for age, race, gender, size of rotator cuff tear, number of anchors utilized, or modifiable risk factors including opioid use and smoking. TXA use independently reduced opioid consumption significantly for the first three days by 18 MME (β=18.0 (-35.4, -0.5), p=0.044). Age also affected opioid use, with older patients consuming slightly fewer opioids than younger patients per year of age (β=-1.5 (-2.5, -0.5), p=0.003). Factors that significantly increased opioid use included prior opioid use (β=64.2 (32.0, 96.3), p<0.001) and increasing number of anchors (per anchor, β=7.9 (4.0, 11.7), p<0.001). No significant differences occurred between groups for VAS at any time point during the first three days postoperative (p=0.238).
Conclusions:
TXA significantly reduced opioid consumption in the first three days after ARCR. Advancing age also modulated postoperative opioid consumption, whereas preoperative opioid use and higher number of anchors increased opioid consumption in the first three days after ARCR. No differences were found in subjective pain rating as measured by the VAS during the first three days postoperatively.
