Comparison of Tranexamic Acid and Dexmedetomidine on Bleeding in Endoscopic Sinus Surgery

Introduction: The quality of the surgical field during the surgery is impaired when bleeding occurs. This study compared the effect of tranexamic acid and dexmedetomidine on the rate of bleeding during endoscopic sinus surgery (ESS). Materials and Methods: In this one-blind clinical trial, ۷۲ patients with chronic rhinosinusitis who were candidates for ESS at Be’sat Hospital in Hamedan were randomly assigned to two groups. Group A received dexmedetomidine at a dose of ۱μg/kg, and group B received tranexamic acid at a dose of ۱۰mg/kg immediately after induction of anesthesia intravenously within ۱۵ minutes. The two groups were evaluated and compared regarding the quality of the surgery field with the Boezaart scale, volume of intraoperative bleeding, hemodynamic changes, and complications up to ۹۰ minutes after the beginning of surgery.   Results: The mean volume of intraoperative bleeding in group A (۱۸۱.۶۷±۸۶.۶۶) was significantly higher than in group B (۱۱۰.۲۸±۶۱.۲۳) (P =۰.۰۰۰). At ۱۵, ۳۰, and ۶۰ minutes, the quality of the surgical field in group B was better than group A (P =۰.۰۳۸), while at ۹۰ minutes, there was no statistically significant difference (P =۰.۴۵۰). The mean arterial pressure in group A at ۱۵ minutes was higher than in group B (P=۰.۰۰۳); at ۶۰ and ۹۰ minutes, it was lower, and the difference was statistically significant (P =۰.۰۱). On the other hand, in ۳۰ minutes, the mean arterial pressure in group A was higher than in group B, without a significant difference (P =۰.۰۷). Moreover, there was no statistically significant difference between the average surgery time (P = ۰.۲۵) and the frequency of complications (P =۰.۴۰۵). Conclusions: Based on the results, tranexamic acid is preferable to injectable dexmedetomidine to control and reduce bleeding during ESS.

Keywords:

Chronic Rhinosinusitis , Dexmedetomidine , Tranexamic acid , Sinus endoscopy