Intravenous Tranexamic Acid Is Marginally Inferior to Epinephrine Irrigation for Visual Clarity During Arthroscopic Rotator Cuff Repair: A Double-Blind, Randomized Controlled Trial.

Purpose: To compare the effects of intravenous tranexamic acid (TXA) versus epinephrine (EPN)-diluted irrigation on visual clarity, surgical outcomes, and safety during arthroscopic rotator cuff repair.

Methods: This study randomized 82 patients (aged 64.9 ± 9.6 years) diagnosed with rotator cuff tears, allocated 1:1 into the TXA and EPN groups. The TXA group received a preoperative intravenous infusion of TXA (15 mg/kg) over 15 minutes with normal saline irrigation, while the EPN group received irrigation with 0.33 mg/L EPN in normal saline without intravenous TXA. Both patients and surgeons were blinded to the interventions. Visual clarity was assessed by surgeons using a numeric rating scale (0-10). Secondary outcomes included operative time, irrigation fluid volume, pump pressure, perioperative hemodynamic parameters, postoperative pain and swelling, and adverse events.

Results: The EPN group showed higher visual clarity scores than the TXA group, with a mean difference of 1.41 (95% confidence interval [CI], 0.55-2.28; P = .002) on a 0 to 10 scale. In contrast, the TXA group exhibited a significantly higher proportion of cases requiring increased pump pressure during surgery compared to the EPN group, with an absolute difference of 34.1% and an odds ratio of 4.4 (95% CI, 1.5-12.7; P = .002). The average pump pressure was also higher in the TXA group than in the EPN group (mean difference, 3.2 mm Hg, 95% CI, 1.36-5.04; P = .001). No serious adverse events were observed.

Conclusions: Intravenous TXA was marginally less effective than EPN irrigation in bleeding control during arthroscopic rotator cuff repair and showed less improvement in visual clarity, with no severe adverse events observed.

Level of evidence: Level I, randomized controlled trial.