Efficacy of Dexamethasone and Tranexamic Acid in Reducing Bleeding, Edema, and Ecchymosis in Rhinoplasty Patients: A Systematic Review and Meta-Analysis.

This study aims to evaluate the efficacy of dexamethasone and tranexamic acid, or a combination of both, in reducing intraoperative bleeding, postoperative edema, and ecchymosis in patients undergoing rhinoplasty. The present review searched PubMed/Medline, ClinicalTrials.gov, and Scopus. The study included randomized clinical trials (RCTs). The efficacy assessment was conducted in terms of intraoperative blood loss, edema score, and ecchymosis score. To evaluate the risk of bias (ROB), the revised version of the Cochrane ROB tool was used. Nine eligible RCTs, including 484 patients undergoing rhinoplasty, were assessed. The overall random-effects pooled prevalence of intraoperative blood reduction was -22.01 ml (95% CI: -34.93 to -9.08; P <0.001). The edema score was -0.87 (95% CI: -1.07 to -0.67, P <0.001), and the ecchymosis score was -0.99 (95% CI: -1.37 to -0.61; P <0.001). The overall quality of the ROB can be moderate, as most studies demonstrated a low ROB in critical domains, but some exhibited concerns in areas such as allocation concealment and blinding, with one study showing a high ROB. The findings indicated that tranexamic acid and dexamethasone significantly improved patient outcomes because they decreased intraoperative bleeding, edema, and ecchymosis. These findings highly suggest that tranexamic acid and dexamethasone should be administered during rhinoplasty.