{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:59:42Z","timestamp":1792479582743,"version":"4.5.0"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82372392"],"award-info":[{"award-number":["82372392"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arthroplasty"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Peri-articular local infiltration analgesia (LIA) is a cornerstone technique in multimodal pain management during the peri-operative period of total knee arthroplasty (TKA). Tranexamic acid (TXA), an antifibrinolytic agent, is widely used to reduce post-operative bleeding in TKA. However, no study has systematically evaluated the impact of adding TXA as an adjuvant to the LIA cocktail on post-operative pain and swelling following TKA. The purpose of this study is to investigate the efficacy and convenience of incorporating TXA into the analgesic cocktail for alleviating pain and swelling after TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this double-blind, randomized controlled trial, 100 patients undergoing TKA were allocated to either a TXA group or a control group. The TXA group received LIA with an analgesic cocktail consisting of ropivacaine, epinephrine, dexamethasone, and TXA, while the control group received an identical cocktail without TXA. The primary outcome was the pain score at rest at 24\u00a0h post-operatively. Secondary outcomes comprised pain scores at other time points, post-operative morphine consumption for rescue analgesia, time to first rescue analgesia, knee swelling rate, decrease in hemoglobin level, range of motion (ROM) of the knee, and incidence of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The TXA group demonstrated significantly lower VAS pain scores at rest at 24\u00a0h post-operatively (3.5\u2009\u00b1\u20090.6 vs. 4.0\u2009\u00b1\u20090.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001, and a markedly smaller decline in hemoglobin levels (26.2\u2009\u00b1\u20097.1\u00a0g\/L vs. 33.5\u2009\u00b1\u20097.5\u00a0g\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001. Knee swelling rates were also significantly reduced in the TXA group. However, the absolute difference in VAS scores did not exceed the reported minimal clinically important difference (MCID) for pain in TKA (typically 1.0 point). No significant differences were observed between the two groups in post-operative morphine consumption, time to first rescue analgesia, knee ROM, or complication rates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The addition of TXA to a commonly used LIA cocktail led to a statistically significant reduction in early post-operative pain and swelling, along with decreased blood loss, which may offer added convenience by streamlining the workflow. However, the reduction in pain did not meet the MCID, indicating limited clinical relevance in terms of analgesia. Future studies are needed to optimize the analgesic efficacy of TXA-containing cocktails.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Chinese Clinical Trial Registry, ChiCTR2400086985. Registered 16 July 2024.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42836-026-00385-8","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T07:19:31Z","timestamp":1776064771000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tranexamic acid in local infiltration analgesia cocktail for pain and swelling after total knee arthroplasty: a randomized controlled trial"],"prefix":"10.1186","volume":"8","author":[{"given":"Qiuru","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changjun","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengde","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"issue":"12","key":"385_CR1","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1530\/EOR-22-0096","volume":"8","author":"PA Vendittoli","year":"2023","unstructured":"Vendittoli PA, Riviere C, Hirschmann MT, Bini S. Why personalized surgery is the future of hip and knee arthroplasty: a statement from the Personalized Arthroplasty Society. EFORT Open Rev. 2023;8(12):874\u201382.","journal-title":"EFORT Open Rev"},{"issue":"5","key":"385_CR2","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1111\/hae.13559","volume":"24","author":"JA Anderson","year":"2018","unstructured":"Anderson JA, Mason JA, Halliday B. Clinical outcomes and patient satisfaction following total hip and knee arthroplasty in patients with inherited bleeding disorders: a 20-year single-surgeon cohort. Haemophilia. 2018;24(5):786\u201391.","journal-title":"Haemophilia"},{"issue":"6S","key":"385_CR3","doi-asserted-by":"publisher","first-page":"S129","DOI":"10.1016\/j.arth.2020.01.028","volume":"35","author":"ST Kunkel","year":"2020","unstructured":"Kunkel ST, Sabatino MJ, Torchia MT, Jevsevar DS, Moschetti WE. Does the impact of joint arthroplasty extend beyond the patient? The effect of total joint arthroplasty on patient\u2019s significant others. J Arthroplasty. 2020;35(6S):S129\u201332.","journal-title":"J Arthroplasty"},{"issue":"15","key":"385_CR4","first-page":"327","volume":"21","author":"F Migliorini","year":"2023","unstructured":"Migliorini F, Feierabend M, Hofmann UK. Fostering Excellence in Knee Arthroplasty: Developing Optimal Patient Care Pathways and Inspiring Knowledge Transfer of Advanced Surgical Techniques. J Healthc Leadersh. 2023;21(15):327\u201338.","journal-title":"J Healthc Leadersh"},{"issue":"10","key":"385_CR5","doi-asserted-by":"publisher","first-page":"3421","DOI":"10.1016\/j.arth.2021.05.014","volume":"36","author":"Q Wang","year":"2021","unstructured":"Wang Q, Hu J, Zeng Y, Li D, Yang J, Kang P. Efficacy of two unique combinations of nerve blocks on postoperative pain and functional outcome after total knee arthroplasty: a prospective, double-blind, randomized controlled study. J Arthroplasty. 2021;36(10):3421\u201331.","journal-title":"J Arthroplasty"},{"issue":"8","key":"385_CR6","doi-asserted-by":"publisher","first-page":"2061","DOI":"10.1016\/j.arth.2024.02.059","volume":"39","author":"Q Wang","year":"2024","unstructured":"Wang Q, Hu J, Ye S, Yang J, Kang P. Efficacy of oral nefopam on multimodal analgesia in total knee arthroplasty: a prospective, double-blind, placebo-controlled, randomized trial. J Arthroplasty. 2024;39(8):2061\u20137.","journal-title":"J Arthroplasty"},{"issue":"6","key":"385_CR7","first-page":"600","volume":"22","author":"YF Lam","year":"2016","unstructured":"Lam YF, Chan PK, Fu H, Yan CH, Chiu KY. A review of the clinical approach to persistent pain following total hip replacement. Hong Kong Med J. 2016;22(6):600\u20137.","journal-title":"Hong Kong Med J"},{"issue":"10","key":"385_CR8","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1097\/EJA.0000000000001853","volume":"40","author":"NI Nielsen","year":"2023","unstructured":"Nielsen NI, Kehlet H, Gromov K, Troelsen A, Husted H, Varnum C, et al. High dose dexamethasone in high pain responders undergoing total hip arthroplasty: A randomized controlled trial. Eur J Anaesthesiol. 2023;40(10):737\u201346.","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"385_CR9","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1097\/EJA.0000000000001768","volume":"40","author":"KS K\u00f8ppen","year":"2023","unstructured":"K\u00f8ppen KS, Gasbjerg KS, Andersen JH, H\u00e4gi-Pedersen D, Lunn TH, Mathiesen O. Systemic glucocorticoids as an adjunct to treatment of postoperative pain after total hip and knee arthroplasty: A systematic review with meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2023;40(3):155\u201370.","journal-title":"Eur J Anaesthesiol"},{"issue":"3","key":"385_CR10","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.bja.2022.10.038","volume":"130","author":"NI Nielsen","year":"2023","unstructured":"Nielsen NI, Kehlet H, Gromov K, Troelsen A, Husted H, Varnum C, et al. High-dose dexamethasone in low pain responders undergoing total knee arthroplasty: a randomised double-blind trial. Br J Anaesth. 2023;130(3):322\u201330.","journal-title":"Br J Anaesth"},{"issue":"6","key":"385_CR11","doi-asserted-by":"publisher","first-page":"492","DOI":"10.2106\/JBJS.23.00854","volume":"106","author":"Q Wang","year":"2024","unstructured":"Wang Q, Jin Q, Cai L, Zhao C, Feng P, Jia J, et al. Efficacy of Diosmin in Reducing Lower-Extremity Swelling and Pain After Total Knee Arthroplasty: A Randomized, Controlled Multicenter Trial. J Bone Joint Surg Am. 2024;106(6):492\u2013500.","journal-title":"J Bone Joint Surg Am"},{"key":"385_CR12","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.24.01511","author":"M Boucher","year":"2025","unstructured":"Boucher M, Tremblay J, Pelet T, Dartus J, Belzile EL, Pelet S. Topical versus systemic tranexamic acid to reduce blood loss after total knee and total hip arthroplasty: a systematic review and meta-analysis. J Bone Joint Surg Am. 2025. https:\/\/doi.org\/10.2106\/JBJS.24.01511.","journal-title":"J Bone Joint Surg Am"},{"key":"385_CR13","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.ijnurstu.2019.06.010","volume":"98","author":"J Zhao","year":"2019","unstructured":"Zhao J, Davis SP. An integrative review of multimodal pain management on patient recovery after total hip and knee arthroplasty. Int J Nurs Stud. 2019;98:94\u2013106.","journal-title":"Int J Nurs Stud"},{"issue":"8","key":"385_CR14","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s11916-023-01137-y","volume":"27","author":"GP Joshi","year":"2023","unstructured":"Joshi GP. Rational multimodal analgesia for perioperative pain management. Curr Pain Headache Rep. 2023;27(8):227\u201337.","journal-title":"Curr Pain Headache Rep"},{"issue":"3","key":"385_CR15","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1093\/bja\/aeu155","volume":"113","author":"L\u00d8 Andersen","year":"2014","unstructured":"Andersen L\u00d8, Kehlet H. Analgesic efficacy of local infiltration analgesia in hip and knee arthroplasty: a systematic review. Br J Anaesth. 2014;113(3):360\u201374.","journal-title":"Br J Anaesth"},{"issue":"5","key":"385_CR16","doi-asserted-by":"publisher","first-page":"354","DOI":"10.2106\/JBJS.22.00614","volume":"105","author":"Q Wang","year":"2023","unstructured":"Wang Q, Zhao C, Hu J, Ma T, Yang J, Kang P. Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am. 2023;105(5):354\u201362.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"385_CR17","doi-asserted-by":"publisher","first-page":"2587","DOI":"10.1007\/s00264-020-04700-z","volume":"44","author":"Q Wang","year":"2020","unstructured":"Wang Q, Sun J, Hu Y, Zeng Y, Hu J, Yang J, et al. Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Int Orthop. 2020;44(12):2587\u201395.","journal-title":"Int Orthop"},{"issue":"1","key":"385_CR18","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s13018-023-03790-w","volume":"18","author":"C Zhao","year":"2023","unstructured":"Zhao C, Wang L, Chen L, Wang Q, Kang P. Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Surg Res. 2023;18(1):301.","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"385_CR19","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1186\/s13018-023-03929-9","volume":"18","author":"YZ Yang","year":"2023","unstructured":"Yang YZ, Cheng QH, Zhang AR, Yang X, Zhang ZZ, Guo HZ. Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):593.","journal-title":"J Orthop Surg Res"},{"issue":"2","key":"385_CR20","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.bja.2022.11.003","volume":"130","author":"CJ DeFrancesco","year":"2023","unstructured":"DeFrancesco CJ, Reichel JF, Gbaje E, Popovic M, Freeman C, Wong M, et al. Effectiveness of oral versus intravenous tranexamic acid in primary total hip and knee arthroplasty: a randomised, non-inferiority trial. Br J Anaesth. 2023;130(2):234\u201341.","journal-title":"Br J Anaesth"},{"issue":"7","key":"385_CR21","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1530\/EOR-2024-0152","volume":"10","author":"S Tantavisut","year":"2025","unstructured":"Tantavisut S, Artykbay S, Tangwiwat P, Susantitaphong P. Topical tranexamic acid in hip and knee surgery: a meta-analysis of randomized-controlled trials. EFORT Open Rev. 2025;10(7):454\u201365.","journal-title":"EFORT Open Rev"},{"key":"385_CR22","doi-asserted-by":"crossref","unstructured":"Li J, Liu R, Rai S, Ze R, Tang X, Hong P. Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty. J Orthop Surg Res. 2020 Dec 2;15(1):581.","DOI":"10.1186\/s13018-020-02119-1"},{"issue":"9","key":"385_CR23","doi-asserted-by":"publisher","first-page":"1312","DOI":"10.1111\/jcpt.13725","volume":"47","author":"T Ling","year":"2022","unstructured":"Ling T, Zhang L, Huang L. The efficacy and safety of combined administration of intravenous and intra-articular tranexamic acid in total knee arthroplasty: an update meta-analysis. J Clin Pharm Ther. 2022;47(9):1312\u201321.","journal-title":"J Clin Pharm Ther"},{"issue":"24","key":"385_CR24","doi-asserted-by":"publisher","first-page":"2053","DOI":"10.2106\/JBJS.16.01525","volume":"99","author":"Z Huang","year":"2017","unstructured":"Huang Z, Xie X, Li L, Huang Q, Ma J, Shen B, et al. Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial. J Bone Joint Surg Am. 2017;99(24):2053\u201361.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"385_CR25","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1016\/j.arth.2014.05.026","volume":"29","author":"Z Huang","year":"2014","unstructured":"Huang Z, Ma J, Shen B, Pei F. Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty. 2014;29(12):2342\u20136.","journal-title":"J Arthroplasty"},{"key":"385_CR26","doi-asserted-by":"crossref","unstructured":"He H, Li C, Wen Z, Zhang W, Doherty M, Zhang Y, Xie J, Wang Y, Xie D, Wei J, Zeng C, Lei G. Which Analgesic Should We Use to Relieve Pain After Knee or Hip Arthroplasty? A Systematic Review and Network Meta-analysis of RCTs. Clin Orthop Relat Res. 2025 Nov 3.","DOI":"10.1097\/CORR.0000000000003749"},{"key":"385_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2020.110098","volume":"68","author":"J Chen","year":"2021","unstructured":"Chen J, Zhou C, Ma C, Sun G, Yuan L, Hei Z, et al. Which is the best analgesia treatment for total knee arthroplasty: adductor canal block, periarticular infiltration, or liposomal bupivacaine? A network meta-analysis. J Clin Anesth. 2021;68:110098.","journal-title":"J Clin Anesth"},{"key":"385_CR28","volume":"10","author":"RA Agha","year":"2025","unstructured":"Agha RA, Mathew G, Rashid R, Kerwan A, Al-Jabir A, Sohrabi C, et al. Transparency In The reporting of Artificial Intelligence-the TITAN guideline. Premier Journal of Science. 2025;10:100082.","journal-title":"Premier Journal of Science"},{"key":"385_CR29","unstructured":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ."},{"issue":"10","key":"385_CR30","doi-asserted-by":"publisher","first-page":"3421","DOI":"10.1016\/j.arth.2021.05.014","volume":"36","author":"Q Wang","year":"2021","unstructured":"Wang Q, Hu J, Zeng Y, Li D, Yang J, Kang P. Efficacy of two unique combinations of nerve blocks on postoperative pain and functional outcome after total knee arthroplasty: a prospective, double-blind, randomized controlled study. J Arthroplasty. 2021;36(10):3421\u201331.","journal-title":"J Arthroplasty"},{"issue":"Suppl 11","key":"385_CR31","first-page":"S240","volume":"63","author":"GA Hawker","year":"2011","unstructured":"Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240\u201352.","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"1","key":"385_CR32","doi-asserted-by":"publisher","first-page":"75.e1","DOI":"10.1016\/j.joms.2019.09.022","volume":"78","author":"L Xie","year":"2020","unstructured":"Xie L, Yang RT, Lv K, Zhou HH, Li Z. Comparison of low pre-emptive oral doses of celecoxib versus acetaminophen for postoperative pain management after third molar surgery: a randomized controlled study. J Oral Maxillofac Surg. 2020;78(1):75.e1-75.e6.","journal-title":"J Oral Maxillofac Surg"},{"issue":"Suppl 1","key":"385_CR33","doi-asserted-by":"publisher","first-page":"S27","DOI":"10.4103\/ija.IJA_1207_20","volume":"65","author":"K Garg","year":"2021","unstructured":"Garg K, Bhardwaj N, Yaddanapudi S, Sen IM, Mathew PJ, Kanojia RP. Efficacy of dexmedetomidine as an adjunct to ropivacaine in transversus abdominis plane block for paediatric laparoscopic surgeries: A double-blinded randomised trial. Indian J Anaesth. 2021;65(Suppl 1):S27-33.","journal-title":"Indian J Anaesth"},{"issue":"3","key":"385_CR34","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1007\/s00167-020-06039-9","volume":"29","author":"Q Wang","year":"2021","unstructured":"Wang Q, Tan G, Mohammed A, Zhang Y, Li D, Chen L, et al. Adding corticosteroids to periarticular infiltration analgesia improves the short-term analgesic effects after total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2021;29(3):867\u201375.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"4","key":"385_CR35","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.bjan.2020.03.015","volume":"70","author":"EP Souza Neto","year":"2020","unstructured":"Souza Neto EP, Usandizaga G. Compara\u00e7\u00e3o entre duas doses de \u00e1cido tranex\u00e2mico intra-articular no sangramento p\u00f3s-operat\u00f3rio de artroplastia total do joelho: estudo cl\u00ednico randomizado [Comparison of two doses of intra-articular tranexamic acid on postoperative bleeding in total knee arthroplasty: a randomized clinical trial]. Braz J Anesthesiol. 2020;70(4):318\u201324.","journal-title":"Braz J Anesthesiol"},{"issue":"1","key":"385_CR36","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1186\/s13018-022-03095-4","volume":"17","author":"D Fan","year":"2022","unstructured":"Fan D, Ma J, Liu X, Zhang L. Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2022;17(1):211.","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"385_CR37","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1186\/s12891-021-04551-8","volume":"22","author":"KI Kim","year":"2021","unstructured":"Kim KI, Bae JK, Kim JH, Gwak HG, Lee SH. Tranexamic acid in a periarticular multimodal cocktail injection for blood management in total knee arthroplasty: a prospective randomized study. BMC Musculoskelet Disord. 2021;22(1):675.","journal-title":"BMC Musculoskelet Disord"},{"issue":"17","key":"385_CR38","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12891-016-1176-7","volume":"26","author":"P Pinsornsak","year":"2016","unstructured":"Pinsornsak P, Rojanavijitkul S, Chumchuen S. Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord. 2016;26(17):313.","journal-title":"BMC Musculoskelet Disord"},{"issue":"3","key":"385_CR39","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1111\/os.14317","volume":"17","author":"S Ye","year":"2025","unstructured":"Ye S, Luo Y, Li Q, Cai L, Kang P. Efficacy of different doses of intra-articular tranexamic acid for reducing blood loss and lower limb swelling after total knee arthroplasty: a prospective, randomized, controlled trial. Orthop Surg. 2025;17(3):733\u201343.","journal-title":"Orthop Surg"},{"issue":"6","key":"385_CR40","doi-asserted-by":"publisher","first-page":"2753","DOI":"10.1007\/s00402-024-05337-y","volume":"144","author":"P Pinsornsak","year":"2024","unstructured":"Pinsornsak P, Thaveekitikul R, Pinsornsak P, Tanariyakul Y. Comparative effectiveness of combined peri-articular and intra-articular injection versus intravenous and intra-articular injection of tranexamic acid in total knee arthroplasty: a randomized controlled trial study. Arch Orthop Trauma Surg. 2024;144(6):2753\u20139.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6S","key":"385_CR41","doi-asserted-by":"publisher","first-page":"S219","DOI":"10.1016\/j.arth.2020.01.069","volume":"35","author":"JW Wurtz","year":"2020","unstructured":"Wurtz JW, Wurtz LD, Ziemba-Davis M, Deckard ER, Meneghini RM. Topical tranexamic acid increases early postoperative pain after total hip arthroplasty. J Arthroplasty. 2020;35(6S):S219\u201325.","journal-title":"J Arthroplasty"},{"issue":"5","key":"385_CR42","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1016\/j.arth.2019.01.030","volume":"34","author":"S Rasamimongkol","year":"2019","unstructured":"Rasamimongkol S, Galassi M, Weerakul S, Pongpirul K. Intra-articular tranexamic acid mitigates blood loss and morphine use after total knee arthroplasty. A randomized controlled trial. J Arthroplasty. 2019;34(5):877\u201381.","journal-title":"J Arthroplasty"},{"issue":"3","key":"385_CR43","doi-asserted-by":"publisher","DOI":"10.1177\/2309499019864693","volume":"27","author":"H Hirose","year":"2019","unstructured":"Hirose H, Ogawa H, Matsumoto K, Akiyama H. Periarticular injection of tranexamic acid promotes early recovery of the range of knee motion after total knee arthroplasty. J Orthop Surg (Hong Kong). 2019;27(3):2309499019864693.","journal-title":"J Orthop Surg (Hong Kong)"},{"issue":"1","key":"385_CR44","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1186\/s12891-022-05058-6","volume":"23","author":"R Hishimura","year":"2022","unstructured":"Hishimura R, Onodera T, Ohkoshi Y, Okada K, Matsuoka M, Matsubara S, et al. The effect of local injection of tranexamic acid into peri-articular tissue versus drain clamping in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord. 2022;23(1):111.","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"385_CR45","doi-asserted-by":"publisher","first-page":"16","DOI":"10.11622\/smedj.2021130","volume":"65","author":"H Sivasubramanian","year":"2024","unstructured":"Sivasubramanian H, Tan CMP, Wang L. Effects of local infiltration of analgesia and tranexamic acid in total knee replacements: safety and efficacy in reducing blood loss and comparability to intra-articular tranexamic acid. Singapore Med J. 2024;65(1):16\u201322.","journal-title":"Singapore Med J"},{"issue":"30","key":"385_CR46","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000016570","volume":"98","author":"S Zhang","year":"2019","unstructured":"Zhang S, Wang C, Shi L, Xue Q. Multi-route applications of tranexamic acid to reduce blood loss after total knee arthroplasty: a randomized controlled trial. Medicine Baltimore. 2019;98(30):e16570.","journal-title":"Medicine Baltimore"},{"issue":"5","key":"385_CR47","doi-asserted-by":"publisher","first-page":"354","DOI":"10.2106\/JBJS.22.00614","volume":"105","author":"Q Wang","year":"2023","unstructured":"Wang Q, Zhao C, Hu J, Ma T, Yang J, Kang P. Efficacy of a Modified Cocktail for Periarticular Local Infiltration Analgesia in Total Knee Arthroplasty: A Prospective, Double-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am. 2023;105(5):354\u201362.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"385_CR48","doi-asserted-by":"publisher","first-page":"2587","DOI":"10.1007\/s00264-020-04700-z","volume":"44","author":"Q Wang","year":"2020","unstructured":"Wang Q, Sun J, Hu Y, Zeng Y, Hu J, Yang J, et al. Effects of morphine on peri-articular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. Int Orthop. 2020;44(12):2587\u201395.","journal-title":"Int Orthop"},{"issue":"1","key":"385_CR49","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s13018-023-03790-w","volume":"18","author":"C Zhao","year":"2023","unstructured":"Zhao C, Wang L, Chen L, Wang Q, Kang P. Effects of magnesium sulfate on periarticular infiltration analgesia in total knee arthroplasty: a prospective, double-blind, randomized controlled trial. J Orthop Surg Res. 2023;18(1):301.","journal-title":"J Orthop Surg Res"},{"key":"385_CR50","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2024.111531","volume":"97","author":"AK Schubert","year":"2024","unstructured":"Schubert AK, Wiesmann T, Wulf H, Obert JDA, Eberhart L, Volk T, et al. The analgetic effect of adjuvants in local infiltration analgesia - a systematic review with network meta-analysis of randomized trials. J Clin Anesth. 2024;97:111531.","journal-title":"J Clin Anesth"}],"container-title":["Arthroplasty"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00385-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42836-026-00385-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42836-026-00385-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T09:04:08Z","timestamp":1776071048000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42836-026-00385-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["385"],"URL":"https:\/\/doi.org\/10.1186\/s42836-026-00385-8","relation":{},"ISSN":["2524-7948"],"issn-type":[{"value":"2524-7948","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]},"assertion":[{"value":"13 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Clinical Trials and Biomedical Ethics Committee of Sichuan University West China Hospital, and written informed consent was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"28"}}