Efficacy of Local Infiltration of Tranexamic Acid and Lidocaine in Tonsillar Bed on Postoperative Bleeding and Pain During Tonsillectomy Surgery: Prospective, Randomized, Control Study
Condition: Post Operative Pain; Postoperative Hemorrhage
MeSH terms: Hemorrhage; Pain, Postoperative; Postoperative Hemorrhage
Study type: Interventional

Summary: 
      All anesthetic techniques aim to lessen intra-operative surgical site bleeding because it is
      a major problem and does not help with precision, surgery time, or postoperative wound
      healing. The main reason for reoperation and mortality in children who have had
      tonsillectomies is post-tonsillectomy hemorrhage. Pre-emptive analgesia reduces surgical pain
      blocking of central sensitization by topical or systemic medications.
    

Detailed description: 
      The control of postoperative pain in children after tonsillectomy is a crucial issue. After a
      tonsillectomy, it is crucial to receive enough postoperative analgesia since discomfort
      limits swallowing, increases the risk of dehydration, infection, and subsequent bleeding, and
      can impede a quick recovery and painless convalescence. Immediately following surgery and
      during the first 24th hours, this pain is at its most intense (1).

      The main reason for reoperation and mortality in children who have had tonsillectomy is
      post-tonsillectomy hemorrhage (PTH). These two categories of PTH as primary bleeding in the
      first 24 hours and secondary bleeding (after 24th hours). Most PTH cases are secondary, with
      incidence reaching its peak between days 5 and 7 after surgery when the fibrin clot breaks
      from the tonsillar fossa. PTH requiring surgical intervention will be an emergency that most
      anesthesiologists will encounter in their clinical practice (2).

      In numerous surgical procedures, bleeding has been observed to be reduced by antifibrinolytic
      transexamic acid (3). It has been demonstrated that transexamic acid can reduce blood loss
      during tonsillectomy but has no impact on whether PTH develops in tonsillectomy patients.
      When administered by nebulization in the emergency room to a patient who was 3 years old,
      tranexamic acid has been found to reduce secondary PTH (4).

      Plasminogen activation is competitively inhibited by tranexamic acid. As a result of
      inhibition of the fibrinolysis, it prevents the clots from being broken down thereby
      significantly reducing surgical hemorrhage. After surgical stress, fibrinolysis occurs more
      frequently, especially in complex surgeries like total knee arthroplasty. Fibrinolysis
      reaches its peak six hours after surgery and continues to occur at a high rate for up to 18
      hours. When administered during this time, tranexamic acid can significantly less blood loss
      (5). In those who are predisposed, thrombosis risk from tranexamic acid exists. Orthostatic
      difficulties, vision abnormalities, headaches, myoclonus, and rash are among other uncommon
      adverse effects.

      The safety and efficacy of tranexamic acid (TXA) have been well studied by surgical services
      including cardiac, orthopedic, dental, trauma, critical care, and dermatologic surgery.
      However, except for craniofacial surgery (6). The most serious problems following a
      tonsillectomy include hemorrhage and respiratory obstruction from edema. The most frequent
      complaint in the initial post-operative phase is pain. With individual differences, the pain
      increases anxiety and the fear of swallowing, predisposes to delayed food intake, reduces
      respiratory effort, increases the risk of pulmonary problems, and lengthens hospital stays
      (7).

      Pre-emptive analgesia, which reduces surgical pain, is the blocking of central sensitization
      by topical or systemic medications. Opioids, steroids, and NSAIDs have all been tested as
      pre-emptive analgesics, as well as local anesthetic sprays and infiltration in the tonsillar
      fossa (8). The use of local anesthetics, opioids, ketamine (9), gabapentin (10),
      corticosteroids, and even non-pharmacologic interventions as adjuvant local analgesic
      compounds has been cited frequently in recent years in children undergoing adenotonsillectomy
      (11).
    

Intervention name(s): lidocaine (2 %) 2 ml and tranexamic acid
Intervention type(s): Drug
Intervention description(s): lidocaine (2 %) 2 ml and tranexamic acid 2 ml in each tonsillar bed
Intervention MeSH terms: Lidocaine; Tranexamic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Tonsillectomy; Lidocaine