Pandher Dilbans Singh, Khosla Nitish, Dhaliwal Pardumanjit Singh
Department of Orthopaedics, SGL Multispeciality Charitable Hospital, Mustafabad, Kapurthala, Punjab, India.
Department of Anaesthesiology, SGL Multispeciality Charitable Hospital, Mustafabad, Kapurthala, Punjab, India.
J Orthop Case Rep. 2025 Apr;15(4):215-220. doi: 10.13107/jocr.2025.v15.i04.5504.
Tranexamic acid (TXA) is widely recognized for its hemostatic properties, particularly in reducing blood loss during surgical procedures. Recent studies, however, suggest that TXA may have potential analgesic benefits beyond its role in hemostasis. This study aims to evaluate the efficacy of intra-articular TXA in reducing post-operative pain and improving early recovery outcomes in patients undergoing total knee arthroplasty (TKA).
Fifty-four patients undergoing simultaneous bilateral TKA were randomly assigned to receive intra-articular TXA in one knee, with the contralateral knee serving as the control. A 1 g dose of TXA, diluted in 10 mL of normal saline, was administered intra-articularly after capsule and skin closure. In addition, 3 g of TXA were administered intravenously (1 g at 30 min preoperatively and 1 g each at 3 and 6 h postoperatively). Closed suction drains were placed for 24 h postoperatively to assess the drainage output. Pain levels were measured using the Visual Analog Scale (VAS) at 48 h, 3 weeks, 6 weeks, and 12 weeks, with the primary outcome being early pain relief and knee range of motion (ROM). Functional outcomes were assessed preoperatively and at 12 weeks follow-up, using the oxford knee score (OKS) and the knee injury and osteoarthritis outcome score for joint replacement (KOOS-JR).
At 48 h postoperatively, the intra-articular TXA group exhibited statistically significant improvements in early pain relief, as measured by VAS scores (P = 0.004), and reduced 24-h closed drain output (P = 0.015) compared to the control group. A greater percentage of patients in the TXA group demonstrated superior knee ROM at 48 h (68.5% vs. 59.3% in the control group). Functional scores, as measured by the OKS and KOOS-JR, improved in both groups, with no significant differences between the study and control knees at the 12-week follow-up.
Intra-articular TXA significantly improves early post-operative pain control and reduces blood loss in TKA patients. These findings suggest that intra-articular TXA can be a valuable adjunct in multimodal analgesia, potentially reducing opioid consumption and enhancing recovery. Further studies are warranted to confirm these results and explore the long-term benefits of TXA in TKA.
氨甲环酸（TXA）因其止血特性而广为人知，尤其是在减少外科手术期间的失血方面。然而，最近的研究表明，TXA可能除了其止血作用外还具有潜在的镇痛益处。本研究旨在评估关节腔内注射TXA对全膝关节置换术（TKA）患者术后疼痛的减轻效果以及改善早期恢复结果的效果。
54例同时接受双侧TKA的患者被随机分配，一侧膝关节接受关节腔内注射TXA，对侧膝关节作为对照。在关节囊和皮肤缝合后，将1 g剂量的TXA用10 mL生理盐水稀释后进行关节腔内注射。此外，静脉注射3 g TXA（术前30分钟注射1 g，术后3小时和6小时各注射1 g）。术后放置闭式引流24小时以评估引流量。在术后48小时、3周、6周和12周使用视觉模拟评分法（VAS）测量疼痛程度，主要结果是早期疼痛缓解和膝关节活动范围（ROM）。术前及术后12周随访时使用牛津膝关节评分（OKS）和关节置换的膝关节损伤和骨关节炎结局评分（KOOS-JR）评估功能结果。
术后48小时，与对照组相比，关节腔内注射TXA组在通过VAS评分测量的早期疼痛缓解方面表现出统计学上的显著改善（P = 0.004），并且24小时闭式引流量减少（P = 0.015）。TXA组中更大比例的患者在48小时时膝关节ROM更佳（68.5%对对照组的59.3%）。两组通过OKS和KOOS-JR测量的功能评分均有所改善，在12周随访时研究组和对照组膝关节之间无显著差异。
关节腔内注射TXA可显著改善TKA患者术后早期的疼痛控制并减少失血。这些发现表明关节腔内注射TXA可以成为多模式镇痛中的一种有价值的辅助手段，可能减少阿片类药物的使用并促进恢复。有必要进行进一步研究以证实这些结果并探索TXA在TKA中的长期益处。
