Seven studies including 579 patients undergoing arthroscopic shoulder surgery for rotator cuff repair were included in this systematic review and meta-analysis comparing the use of tranexamic acid (TXA) versus saline and epinephrine versus TXA. Pooled outcomes of interest included visual clarity, operative time, the volume of irrigation fluid used, mean arterial pressure, and postoperative pain. The meta-analysis showed that visual clarity was significantly better with TXA compared to saline and with epinephrine compared to TXA. However, there was no significant difference in TXA use in operative time, mean arterial pressure, volume of irrigation used, or postoperative pain scores. The findings suggest that while TXA and epinephrine can improve visual clarity, this does not translate to significant clinical improvements in operative time or pain relief.