7. Effect of tranexamic acid on blood loss and quality of surgical field in trans-sphenoidal surgery

Background: The aim of this study is to assess the effect of preoperative bolus followed by intraoperative infusion of tranexamic acid on intraoperative blood loss and the quality of surgical field in trans-sphenoidal surgery. Materials and Methods: A prospective randomized double blind study was carried out in 50 ASA grade I-II patients presenting for elective trans-sphenoidal pituitary surgery for pituitary tumors. One group received bolus intravenous dose of tranexamic acid (25 mg/kg) followed by infusion (1/mg/kg/hr) of the same till the end of surgery while the placebo group received normal saline in the same amount. All patients were analyzed for preoperative color perception, intraoperative hemodynamic monitoring, hematocrit, arterial blood gas values, quality of surgical field (Boezaart scale), amount of blood loss and anaesthetic requirements. Results: The demographic, hemodynamic and anesthetic parameters, duration of surgery, amount of intraoperative fluid and urine output were comparable in both the groups. The tranexamic group had significantly better quality of surgical field (Boezaart score 2.64 ±0.638 vs. 3.08 ± 0.759, P = 0.031) and lesser blood loss (334 ± 101 vs. 495 ± 226 ml, P =0.02) than the placebo group. Conclusions: Despite widespread use in other surgical specialities, tranexamic acid is rarely used in neurosurgical operations. In standard doses, it is found to be effective in traumatic brain injury and spinal surgery. Therefore, unless contraindications exist, tranexamic acid can be tried in neurosurgery. Conclusion: Intraoperative use of tranexamic acid improves the quality of surgical field as well as reduces bleeding in patients undergoing trans-sphenoidal resection of pituitary tumors.

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