Comparative Efficacy of Desmopressin, Tranexamic Acid, and Phenylephrine in Reducing Bleeding and Improving Surgical Field Quality during Rhinoplasty: A Triple-Blind Randomized Controlled Trial.

[BACKGROUND] Rhinoplasty, a popular cosmetic surgery, often faces intraoperative bleeding, which reduces surgical visibility and increases postoperative periorbital edema and ecchymosis. This study compared the effects of desmopressin, tranexamic acid, and phenylephrine on reducing bleeding and improving surgical field quality in rhinoplasty.

[METHODS] In this triple-blind clinical trial, 80 patients aged 18-50 undergoing rhinoplasty were randomly divided into four groups: tranexamic acid, phenylephrine, desmopressin, and control. Surgical field quality was assessed using the Boezaart scale, and bleeding volume was measured by weighing blood-soaked gauze and suction fluid. Data were recorded at 15, 30, 45, and 90-minute intervals and analyzed using SPSS 24.

[RESULTS] There were no significant differences in demographic or laboratory characteristics among the groups (p > 0.05). The desmopressin and tranexamic acid groups had less bleeding than the control group at 30, 45, and 90 min (p < 0.05), while phenylephrine was effective only at 30 and 45 min (p < 0.05). The quality of the surgical field was better in the desmopressin and tranexamic acid groups at all time points (p < 0.05), but phenylephrine showed improvement only at 15 and 30 min (p < 0.05). Additionally, all intervention groups had a shorter operative time duration compared to the control group (p < 0.05).

[CONCLUSION] Desmopressin, tranexamic acid, and phenylephrine, in that order, were the most effective in reducing bleeding and improving surgical field quality. Additionally, these drugs reduced operative time, highlighting their potential to benefit patients and facilitate surgical procedures for surgeons.

[TRIAL REGISTRATION] IRCT20240712062409N1 LEVEL OF EVIDENCE I: 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 .