Effect of Tranexamic Acid on Visualization Clarity and Bleeding in Shoulder Arthroscopy: A Randomized Controlled Study.

BACKGROUND: Shoulder arthroscopy has become increasingly popular over the past decade. During this procedure, bleeding directly affects visualization and influences both intraoperative visibility and postoperative outcomes by causing hemarthrosis. AIM: The aim of this study was to investigate the effect of TXA on intraoperative visualization quality through reduction of bleeding. PATIENTS AND METHODS: One hundred and twenty patients were divided into three groups: the intravenous (IV) group received 15 mg/kg of TXA, the local group received 250 mg of TXA added to 3000 cc of irrigation solution, and the placebo group received no TXA administration. During surgery, visualization quality was assessed every 15 minutes as Grade I - poor, Grade II - good, Grade III - excellent. Preoperative and postoperative hemoglobin (Hb) levels, as well as American Shoulder and Elbow Surgeons; Constant; and Disabilities of the Arm, Shoulder, and Hand scores, were recorded. Intraoperative and postoperative blood loss was calculated for all patients. RESULTS: Visualization was significantly better in the groups that received TXA compared to the placebo group, with the IV group demonstrating superior clarity over the local group. Hb loss was lower in the IV group compared to both the local and placebo groups. Intraoperative blood loss was significantly lowest in the IV group, followed by the local group, and highest in the placebo group. All groups showed a significant postoperative improvement in shoulder scores. CONCLUSIONS: TXA reduces both intraoperative and postoperative bleeding during shoulder arthroscopy and enhances visualization. Its effects are more pronounced when administered intravenously, as it significantly decreases Hb loss compared to local application and placebo.