Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis

Mehdizadeh, Mohammad; Ghassemi, Alireza; Khakzad, Mohammad Reza; Mir, Mehrafza; Nekoohesh, Leili; Moghadamnia, Ali Akbar; Bijani, Ali; Mehrbakhsh, Zahra; Ghanepur, Hosein

doi:10.1007/s00266-017-0969-x

Cited by 47 publications

(65 citation statements)

References 24 publications

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“…The search strategy identified 82 relevant articles in the databases. Eleven RCTs [13–23] were selected after reading the abstracts and full text carefully. All of the documents are high quality articles.…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias is represented in Figures 2 and 3. Seven studies [15,16,18,20–23] were for FESS, 3 studies [13,14,17] were for rhinoplasty, and 1 study [19] was for septorhinoplasty. There were 7 articles had been published in recent 3 years, and the longest article included was published in 2006.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [13,14,19] provided the data of edema and ecchymosis rating of upper and lower eyelid, two of them were rhinoplasty and one is about septorhinoplasty. The same evaluation index of eyelid edema and ecchymosis used in the three literatures (Fig.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…Seven studies [13–15,19–22] stated the operation time. Two types of surgery are included in this outcome, so we established a subgroup analysis.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

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Role of tranexamic acid in nasal surgery

et al. 2019

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Objective: Nasal surgeries (such as Functional Endoscopic Sinus Surgery, Rhinoplasty, and Septorhinoplasty) are popular procedures. But perioperative bleeding, eyelid edema, and periorbital ecchymosis remain problems. Tranexamic acid (TXA) is an antifibrinolytic, and it was used to reduce the perioperative bleeding. However, there is no enough evidence judging its safety and efficiency. Therefore, a meta-analysis is conducted by us to evaluate the role of TXA in patients undergoing nasal surgeries. Method: A search of the literature was performed until June 2018; the PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. Only randomized controlled trial (RCT) articles were included, and subgroup analysis was established to deal with heterogeneity. RevMan 5.3 software was selected to conduct the meta-analysis. Result: Eleven RCTs were included in our meta-analysis. There were significant differences in blood loss ( P < .001), surgical field quality ( P < .001), edema rating of upper ( P < .001) and lower ( P < .001) eyelid, ecchymosis rating of upper ( P < .001) and lower eyelid ( P < .001) when comparing the TXA group to the placebo group. However, the difference in operation time ( P = .57) was not significant between the two groups. Conclusion: Perioperative TXA could reduce the blood loss and improve the quality of surgery field during nasal surgery, and it was helpful for reducing the edema and ecchymosis after nasal surgeries, but it has little influence in reducing the operation time.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Meta-analysis Resultsmentioning

confidence: 99%

“…Seven studies [13–15,19–22] stated the operation time. Two types of surgery are included in this outcome, so we established a subgroup analysis.…”

Section: Meta-analysis Resultsmentioning

confidence: 99%

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Role of tranexamic acid in nasal surgery

et al. 2019

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“…Preventing or at least reducing the severity of periorbital edema and ecchymosis associated with surgical intervention is essential in maintaining patient safety and increasing patient satisfaction [6][7][8][9] . There are various studies in the literature examining the effect of different methods such as steroids [9][10][11][12] , cold application 5,7,13 and local heparinoid (mucopolysaccharide polysulphate) 6,8 on periorbital edema and ecchymosis. All of these studies, except the Shin et al's study 5 , were conducted with patients treated with rhinoplasty, and there is currently only one study that was conducted with patients with craniotomy.…”

Section: Introductionmentioning

confidence: 99%

Effect of Cold Application and Heparinoid on Periorbital Edema and Ecchymosis After Craniotomy: A Randomized Controlled Clinical Trial

Akyolcu¹

2020

jamp

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This study was performed to determine the effect of cold application and heparinoid cream on periorbital edema and ecchymosis after craniotomy. The sample of this prospective parallel-arm, randomized controlled trial included 90 neurosurgical patients who underwent anterior craniotomy in two medical faculty hospitals of a university in Turkey. The patients were randomly assigned (1:1:1) to the cold application, heparinoid or control groups. Those patients in the cold application group received cold application with gel pack on their periorbital areas for 20 minutes per hour for three days beginning from the 3 rd hour following craniotomy. On the other hand, the patients in the heparinoid group received heparinoid cream on their periorbital areas once at the 3 rd and 9 th hours after craniotomy and then four times/day at 6-hour intervals for three postoperative days. Periorbital edema and ecchymosis were evaluated for three days after craniotomy using Kara & Gökalan's scale by blinded observers. In all the measurements after craniotomy, except for those at the 3 rd hour, the periorbital edema score of the cold application group was significantly lower than those of both the heparinoid and control groups (p<0.001). The upper and lower eyelid ecchymosis scores of the cold application group were significantly lower than those of both the heparinoid and control groups on the 1 st , 2 nd and 3 rd days after craniotomy (p<0.001). In the cold application group, periorbital edema score decreased significantly as the skin temperature decreased only on the 3 rd day after craniotomy (p=0.01). The study revealed that cold application and heparinoid cream administered for three days beginning from the 3 rd hour after craniotomy did not prevent postoperative periorbital edema and ecchymosis, but cold application significantly reduced periorbital edema and ecchymosis.

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Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty

McGuire

Nurmsoo

Samargandi

et al. 2019

JAMA Facial Plast Surg

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IMPORTANCE Blood loss from surgical procedures is a major issue worldwide as the demand for blood products is increasing. Tranexamic acid is an antifibrinolytic agent commonly used to reduce intraoperative blood loss.OBJECTIVE To systematically examine the role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.DATA SOURCES A systematic review and meta-analysis was undertaken in an academic medical setting using Medline, Embase, and Google Scholar from inception to June 30, 2018. All references of included articles were screened for potential inclusion. The search was mapped to Medical Subject Headings, and the following terms were used to identify potential articles: reconstruction or rhinoplasty and tranexamic acid or anti-fibrinolysis or antifibrinolysis and bleeding or ecchymosis or bruising or edema or complications.STUDY SELECTION The population of interest consisted of adult patients undergoing primary elective rhinoplasty. The intervention was the use of tranexamic acid. The control group was composed of patients receiving a placebo. Primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis. In vitro or animal studies were excluded, and only English-language articles were included.DATA EXTRACTION AND SYNTHESIS The PRISMA guidelines were followed, and articles were assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Random-effects meta-analysis was performed to determine the overall effect size. MAIN OUTCOMES AND MEASURESThe primary outcomes were intraoperative blood loss and postoperative edema and ecchymosis.RESULTS Five studies (comprising 332 patients) were included in the qualitative analysis, all of which were randomized clinical trials published within the past 5 years. The mean (SD) patient age was 27 ( 7) years (age range, 16-42 years), while the mean (SD) sample size was 66 (19) (range, 50-96). Meta-analysis of 4 studies (271 patients) indicated that tranexamic acid treatment resulted in a mean reduction in intraoperative blood loss of −41.6 mL (95% CI, −69.8 to −13.4 mL) compared with controls (P = .004). Three studies indicated that postoperative edema and ecchymosis were reduced with tranexamic acid treatment compared with controls; however, there was no significant difference compared with corticosteroid use. Four studies were considered of high methodological quality, with a low risk of bias. The overall quality of evidence was high.CONCLUSIONS AND RELEVANCE Tranexamic acid has the ability to significantly reduce intraoperative blood loss and postoperative edema and ecchymosis among patients undergoing primary elective rhinoplasty.LEVEL OF EVIDENCE 4.

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Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis

Abstract: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Cited by 47 publications

References 24 publications

Role of tranexamic acid in nasal surgery

Role of tranexamic acid in nasal surgery

Effect of Cold Application and Heparinoid on Periorbital Edema and Ecchymosis After Craniotomy: A Randomized Controlled Clinical Trial

Role of Tranexamic Acid in Reducing Intraoperative Blood Loss and Postoperative Edema and Ecchymosis in Primary Elective Rhinoplasty

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