Fifty-four patients undergoing simultaneous bilateral total knee arthroplasty were randomized in a self-controlled design, receiving intra-articular tranexamic acid (TXA) in one knee (n=54) and no intra-articular TXA in the contralateral knee (n=54). The primary outcome was early postoperative pain relief. Secondary outcomes included range of motion (ROM), functional scores (Oxford Knee Score and KOOS-JR), and drain output volume. Outcomes were assessed at 48 hours, 3 weeks, 6 weeks, and 12 weeks postoperatively. Overall, the results of the study revealed that intra-articular TXA significantly reduced pain at 48 hours and drain output compared to control. No significant differences in functional scores or ROM were observed at later time points. These findings suggest that intra-articular TXA can enhance early recovery and reduce immediate postoperative discomfort in TKA patients.