# Postoperative pain evaluation in laparoscopic radical prostatectomy surgery using tranexamic acid: analgesia?, hyperalgesia??

## TL;DR

This study examines whether tranexamic acid affects postoperative pain and bleeding in prostatectomy patients, finding possible increased pain but no significant bleeding reduction.

## Contribution

The study provides new insights into tranexamic acid's potential to cause hyperalgesia in laparoscopic prostatectomy patients.

## Key findings

- TXA group had higher VAS scores at postoperative 0th and 6th hours, suggesting increased pain.
- TXA group required more rescue analgesia and sooner than the control group.
- No significant difference in bleeding outcomes between the groups.

## Abstract

Tranexamic acid(TXA), an antifibrinolytic agent, is widely used to reduce bleeding, but its effect on pain is not clear.The purpose of this study was to evaluate the effectiveness of intravenous TXA on postoperative pain and bleeding in patients undergoing laparoscopic radical prostatectomy(LRP).

Our study was conducted as a prospective, observational study. Seventy patients aged 18-75years, ASA II-III, who would undergo LRP surgery under general anesthesia were included in the study.After anaesthesia induction, maintenance was provided with desflurane and 0.1-0.5mcg/kg/min remifentanil infusion with BIS monitoring.The control group(Group C) (n = 35) received 100 ml of saline and the study group(Group TXA) (n = 35) received TXA 15 mg/kg bolus 10 min before the incision and then 100 mg/hour infusion until skin closure. Demographic, hemodynamic data, ASA, education level, duration of operation and anesthesia, bleeding, administered fluid and remifentanil amounts, hemoglobin values(at the beginning of the operation, 2nd hours, end of the operation, postoperative 12th, 24th hours), Visual Analog Scale (VAS) (at 0th, 6th, 12th, 24th hours postoperatively), time to first rescue analgesia requirement, number of rescue analgesia used within 24h and side effects were recorded.

It was observed that VAS scores were statistically higher in TXA group at postoperative 0th and 6th hours, postoperative rescue analgesia requirement was higher and first rescue analgesia requirement time was shorter. No difference was determined between the groups in terms of other parameters.

In our study, we concluded that there was no significant difference in terms of bleeding in patients who were administered TXA, but this agent may cause hyperalgesia and a special approach to analgesia should be taken in cases where it is decided to be used.

(NCT06040853)