- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03965767
Does The Combined Use Of Local And Intravenous Tranexamic Acid Offer Better Surgical Field Quality During Functional Endoscopic Sinus Surgery? A Placebo-Controlled Clinical Trial
Functional Endoscopic Sinus surgery (FESS) is a surgery done for chronic rhinosinusitis after failure of medical treatment. Intraoperative bleeding poses a challenge to both the surgeon and anaesthetist. Although blood loss is not massive during FESS, bleeding may obscure the surgical field prolonging the time of surgery or even leading to incompletion of the surgery.
Different methods have been used to improve the surgical field but none without side effects. The use of diathermy carries the risk of local tissue damage with the risk of subsequent bleeding. Local vasoconstrictors carry the risk of systemic absorption. Induced hypotension may not be suitable for all patients; besides, this may necessitates the use of more anaestheic drugs with their associated side effects. In addition, none of theses methods have provided ideal surgical field for the surgeon.1-3 Tranexamic acid, an antifibrinolytic agent, has been used to decrease surgical field bleeding in different surgeries showing effectiveness in its topical, oral and intravenous use.4-6 The aim of this study is to evaluate the effectiveness of local, intravenous and combined use of tranexamic acid in improving the surgical field quality during functional endoscopic sinus surgery.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
After obtaining local ethical committee approval and written informed consent from the patients, 90 adult patients of both sex, aged between 18 and 50 years, ASA I-II, scheduled for elective functional endoscopic sinus surgery in Ain Shams University hospitals will be enrolled in this randomized, controlled prospective double blinded study.
Exclusion criteria included; patients with uncontrolled hypertension or coronary artery disease, anaemia, end stage renal failure, liver cirrhosis, patients with coagulopathy or receiving drugs influencing blood coagulation, cerebrovascular thrombosis or history of thrombotic events, pregnancy, known sensitivity to any of the study drug and patients' refusal to participate in the study.
The surgeon will assess the degree of sinus involvement in each patient using the Lund-Mackay scoring system. All the patients will be instructed to take prednisone 1 mg. kg-1 5 days before surgery to reduce inflammation.
After applying basic monitors, all patients will be premedicated with midazolam 0.05 mg.kg -1 IV, ranitidine 50 mg IV and dexamethasone 10 mg IV, 15 min. prior to surgery.
In the operating room and after 5 min preoxygenation, general anesthesia will be conducted using the same protocol for all patients: fentanyl 1 μg.Kg-1, propofol 2-2.5 mg.kg -1 and atracurium 0.5 mg. Kg-1 to facilitate endotracheal intubation.
Anaesthesia will be maintained using isoflurane 1 -1.5% in oxygen and air mixture 1:1 and atracurium 0.1 mg. Kg-1 every 30 mim. Positive pressure ventilation was set to maintain normocapnia. Fentanyl bolus of 0.5 μg.Kg-1 to maintain MAP (60-70 mmHg), without exceeding a total dose of 5 μg.Kg-1 for fast tracking and early extubation. Total dose of fentanyl will be recorded.
A throat pack soaked with saline will be inserted in all patients to prevent blood from reaching the gastrointestinal track. The surgeon will insert nasal pack (epinephrine 1/2000 soaked pack), Afterwards, he will inject 2 ml of epinephrine 1:100000 into the middle turbinate and the junction of the middle turbinate to the lateral nasal wall. All patients will be placed in the same position.
Patients will then be randomly and evenly assigned to one of the four groups, 30 patients each.
Group I: patients will receive an intravenous dose of 15 mg.kg-1 of tranexamic acid in a 10 ml syringe. The irrigation fluid will be 400 ml of normal saline.
Group II: patients will receive intravenous dose of 10 ml normal saline in 10 ml syringe. Irrigation fluid will be 400 ml of normal saline with 2 g of tranexamic acid added to it. If more irrigation is needed, normal saline will be used.
Group III: patients will receive an intravenous dose of 15 mg.kg-1 of tranexamic acid in a 10 ml syringe. Irrigation fluid will be 400 ml of normal saline with 2 g of tranexamic acid added to it. If more irrigation is needed, normal saline will be used.
Group IV (control): patients will receive intravenous dose of 10 ml normal saline in 10 ml syringe. The irrigation fluid will be 400 ml of normal saline.
Randomization was done using computer generated list. A pharmacist will prepare the drugs, as well as the irrigation fluid, which will only have the patient's number on them. In this way, the anaesthetist and the surgeon will be blinded to the study groups. The same surgeon performed all the operations.
In all groups, if bleeding was uncontrollable and affecting the surgical field, loading dose of esmolol 500 μg.Kg-1 will be started, followed by infusion of 100-300 mg.Kg-1.min-1. The use and total dose of esmolol will be reported.
MAP and HR will recorded before induction of anaesthesia (baseline), immediately after induction, and every 15 mim till completion of surgery.
Beside the maintenance fluid infusion, intraoperative blood loss will be compensated with crystalloids in a ratio of 1:3.
Prothrombin time (PT), partial thromboplastin time (PTT) and complete blood count (CBC) will be measured before surgery and 6 hours after surgery.
The surgeon will be asked to estimate the surgical field on a 5-point Boezaart scale immediately at the end of the surgery (table 1).
Table 1: Surgical field quality based on Boezaart scale. 7 Grade Assessment 0 No bleeding.
- Slight bleeding, no suction of blood required.
- Slight bleeding, occasional suction required.
- Slight bleeding, frequent suction required. Bleeding threatens surgical field few seconds after suction is removed.
- Moderate bleeding, frequent suction required. Bleeding threatens surgical field directly after suction is removed.
- Severe bleeding, constant suction required. Bleeding appears faster than can be removed by suction. Surgical field severely threatened and surgery not possible
The incidence of postoperative complications including; epistaxis, nausea, vomiting and pain (using VAS) will be evaluated in the PACU.
Study Type
Enrollment (Anticipated)
Phase
- Phase 3
Contacts and Locations
Study Contact
- Name: Research ethics comittee
- Phone Number: 202 26857539
- Email: fathytash@yahoo.com
Study Locations
-
-
-
Cairo, Egypt
- Recruiting
- Faculty of Medicine Ain shams University
-
Contact:
- ossama mady, MD
- Phone Number: 202 01117341201
- Email: omady84@gmail.com
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- patients underwent endoscopic sinus surgery
Exclusion Criteria:
- patients with uncontrolled hypertension or coronary artery disease, anaemia, end stage renal failure, liver cirrhosis, patients with coagulopathy or receiving drugs influencing blood coagulation, cerebrovascular thrombosis or history of thrombotic events, pregnancy, known sensitivity to any of the study drug and patients' refusal to participate in the study.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: TREATMENT
- Allocation: RANDOMIZED
- Interventional Model: PARALLEL
- Masking: TRIPLE
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
PLACEBO_COMPARATOR: control
|
comparison of effect of tranexamic acid on control of bleeding when used locally in the nose or systemic use
|
ACTIVE_COMPARATOR: local group
|
comparison of effect of tranexamic acid on control of bleeding when used locally in the nose or systemic use
|
ACTIVE_COMPARATOR: systemic group
|
comparison of effect of tranexamic acid on control of bleeding when used locally in the nose or systemic use
|
ACTIVE_COMPARATOR: combined local and systemic
|
comparison of effect of tranexamic acid on control of bleeding when used locally in the nose or systemic use
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
bleeding during surgery
Time Frame: time of surgery
|
surgeon satisfaction
|
time of surgery
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start (ACTUAL)
Primary Completion (ANTICIPATED)
Study Completion (ANTICIPATED)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (ACTUAL)
Study Record Updates
Last Update Posted (ACTUAL)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- FMASU R 27-2019
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Nasal Polyps
-
Poitiers University HospitalNot yet recruiting
-
Ohio State UniversityActive, not recruitingChronic Rhinosinusitis With Nasal Polyps | Chronic Rhinosinusitis Without Nasal PolypsUnited States
-
Johns Hopkins UniversityGlaxoSmithKlineTerminatedPatients With Nasal Polyps
-
GB001, Inc, a wholly owned subsidiary of Gossamer...CompletedChronic Rhinosinusitis Without Nasal Polyps (CRSsNP) | Chronic Rhinosinusitis With Nasal Polyps (CRSwNP)United States, Czechia, Ukraine
-
Optinose US Inc.CompletedBilateral Nasal PolyposisUnited States
-
St. Paul's Sinus CentreRecruitingAsthma | Chronic Rhinosinusitis With Nasal Polyps | Chronic Rhinosinusitis Without Nasal PolypsCanada
-
Christiane HaaseActive, not recruitingAsthma | Chronic Rhinosinusitis (Diagnosis) | Chronic Rhinosinusitis With Nasal Polyps | Chronic Rhinosinusitis Without Nasal PolypsDenmark
-
Fondazione Policlinico Universitario Agostino Gemelli...Not yet recruitingChronic Rhinosinusitis With Nasal PolypsItaly
-
Medical University of South CarolinaRecruitingChronic Rhinosinusitis With Nasal PolypsUnited States
-
Fondazione Policlinico Universitario Agostino Gemelli...Active, not recruitingChronic Rhinosinusitis With Nasal PolypsItaly
Clinical Trials on Tranexamic Acid
-
Icahn School of Medicine at Mount SinaiRecruiting
-
University of LiegeCompletedArthroplasty Complications | Hemorrhage Postoperative | Total Blood LossBelgium
-
London School of Hygiene and Tropical MedicineCompleted
-
Samsung Medical CenterUnknownBleeding | Transfusion Related ComplicationKorea, Republic of
-
Assiut UniversityCompleted
-
Thammasat UniversityCompleted
-
Ferring PharmaceuticalsCompleted
-
Ain Shams UniversityCompleted
-
Aswan University HospitalCompletedCesarean Section ComplicationsEgypt
-
London School of Hygiene and Tropical MedicineRawalpindi Medical CollegeCompletedPregnancy, High RiskPakistan, Zambia