Mohammad Mehdizadeh1,2, Alireza Ghassemi3,4, Mohammad Khakzad5, Mehrafza Mir6, Leili Nekoohesh7, Aliakbar Moghadamnia8, Ali Bijani9, Zahra Mehrbakhsh10, Hosein Ghanepur11,12. 1. Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, Iran. 2. Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran. 3. Consultant Oral and Maxillofacial Surgeon, Klinikum Lippe, Academic Hospital of the University of Göttingen, Detmold, Germany. 4. Medical Faculty University RWTH Aachen, Aachen, Germany. 5. Department of Plastic Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran. 6. Department of Anesthesiology and Intensive Care, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran. 7. Department of Medical Biotechnology, School of Advanced Medical Technologies, Tehran University of Medical Sciences, Tehran, Iran. 8. Department of Pharmacology and Toxicology, Babol University of Medical Sciences, Babol, Iran. 9. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. 10. Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran. 11. Department of Oral and Maxillofacial Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran. hghanepur@yahoo.com. 12. Department of Oral and Maxillofacial Surgery, 5 Azar Hospital, Golestan University of Medical Sciences, 5 Azar Street, Gorgan, Iran. hghanepur@yahoo.com.
Abstract
BACKGROUND:Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. METHODS: A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups. RESULTS: In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT. CONCLUSION:Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard. LEVEL OF EVIDENCE III: 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 .
RCT Entities:
BACKGROUND:Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. METHODS: A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0-4. Periorbital edema and ecchymosis were examined in all groups. RESULTS: In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT. CONCLUSION:Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard. LEVEL OF EVIDENCE III: 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 .
Authors: Sara Juliana de A de Vasconcellos; Edmundo M do Nascimento-Júnior; Marcel Vinícius de Aguiar Menezes; Mário Luis Tavares Mendes; Rafael de Souza Dantas; Paulo Ricardo Saquete Martins-Filho Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-09-01 Impact factor: 6.223