EFFICACY OF LOCAL TRANEXAMIC ACID INFILTRATION IN REDUCING INTRA-OPERATIVE BLEEDING DURING WIDE AWAKE LOCAL ANESTHESIA NO TOURNIQUET HAND SURGERY: A QUASI-EXPERIMENTAL STUDY

Abstract

Objectives: To investigate the effectiveness of local administration of tranexamic acid (TXA) in reducing intraoperative blood loss and improving surgical field visualization during (WALANT) hand surgery

Study design: Prospective quasi-experimental study

Study setting and duration: Holy Family Hospital Rawalpindi from April 2025 till  June 2025

Methodology: 100 patients were included, using non-probability consecutive sampling methods. Each patient was randomly assigned to one of two treatment groups (n=50 each); one Control group received standard WALANT (lignocaine with adrenaline), and the second TXA group received the same WALANT solution with an added concentration of 10 mg/ml. The primary outcomes of the study were assessed using two instruments: (1) the Boezaart Surgical Field Scale score and (2) immediate postoperative complications. Data was analyzed using SPSS, using descriptive statistics and Chi-Square.

Results: The TXA group experienced better surgical field visualization as evidenced by (1) seventy percent of TXA participants achieved a Boezaart Surgical Field Scale score of 0 (clear field) or 1 (unclear but visible field), and no participants in the Control group achieved these scores (p<0.001). The TXA group had fewer immediate postoperative complications (74% TXA vs. 30% Control) (p<0.001), and at 1 and 3 weeks postoperatively, there were no statistically significant differences (p=0.663 and p=0.260, respectively) between groups.

Conclusion: The use of TXA via local infiltration (hemostasis enhancement via a local anesthetic) improves surgical clarity (the amount of blood in the surgical field) and has no increased incidence of complications.