Abstract:Objective To explore the efficacy and safety of local application of tranexamic acid combined with epinephrine in posterior surgery for thoracolumbar burst fractures. Methods Eighty patients who underwent posterior surgery for thoracolumbar burst fractures at the Second People’s Hospital of Hunan Province from June 2022 to June 2024 were randomly divided into two groups，with 40 cases in each group. The observation group received local application of tranexamic acid combined with epinephrine，while the control group received local application of an equal volume of sodium chloride injection. The following indicators were compared between the two groups：drainage volume at 8 hours and 24 hours after surgery，total drainage volume，drainage tube removal time，changes in hemoglobin（Hb）and D-dimer levels before surgery as well as at 24 hours and 72 hours after surgery，postoperative Visual Analog Scale（VAS）scores，and the incidence of postoperative complications. Results The total postoperative drainage volume in the observation group was significantly lower than that in the control group［（336.63±62.87）mL vs（421.30±75.44）mL，t=5.45，P<0.01］，and the drainage tube removal time was significantly shorter［（69.55±16.57）hvs（85.23±13.51）h，t=4.64，P<0.01］. There was no significant difference in D-dimer levels between the two groups at24 hours and 72 hours after surgery（P>0.05）. The postoperative Hb levels in both groups decreased significantly from24 hours to 72 hours after surgery，but the level in the observation group was significantly higher than that in the control group，with a significant interaction effect （P<0.01）. The postoperative VAS scores in both groups decreased significantly from 1 day to 3 days and then to 7 days after surgery，and the VAS scores in the observation group were significantly lower than those in the control group at all time points，with a significant interaction effect（P<0.01）. After surgery，except for 1 case of incision infection in the control group，no complications such as incision infection，deep vein thrombosis，or aggravated nerve compression occurred in other patients. Conclusion Local application of tranexamic acid combined with epinephrine in posterior surgery for thoracolumbar burst fractures can significantlyreduce postoperative drainage volume，shorten drainage tube removal time，exert a hemostatic effect，alleviate pain，and does not increase the risk of postoperative complications，showing good safety.