The Impact of Local Tranexamic Acid Infiltration on Periorbital Ecchymosis and Edema in Rhinoplasty: A Triple-Blinded Randomized Controlled Trial

TL;DR

A study tested if injecting tranexamic acid during rhinoplasty reduces eye swelling and bruising but found no significant benefits compared to a placebo.

Contribution

This is the first triple-blinded randomized trial evaluating local tranexamic acid infiltration's effect on periorbital complications in rhinoplasty.

Findings

TXA infiltration did not significantly reduce periorbital edema or ecchymosis at 24 hours or one week post-surgery.

Intraoperative bleeding was slightly lower in the TXA group but not statistically significant.

Local TXA may not offer benefits in rhinoplasty as seen with systemic administration.

Abstract

Rhinoplasty is acknowledged as one of the most commonly conducted facial plastic surgical procedures worldwide. Periorbital ecchymosis and edema pose considerable postoperative complications that influence patient satisfaction and recovery duration.

This study aimed to examine the impact of local tranexamic acid (TXA) infiltration on periorbital ecchymosis and edema in patients undergoing rhinoplasty.

A randomized, triple-blind, controlled trial was conducted involving 80 patients scheduled for primary open septorhinoplasty at our university hospital between 2021 and 2022. Participants were randomly allocated to receive either local infiltration consisting of TXA (1 mg/mL) combined with lidocaine and epinephrine (n = 40) or a control solution containing identical components, except TXA (n = 40). Periorbital ecchymosis and edema were evaluated at 24 h and 1 week postoperatively, utilizing a standardized scale.

No significant differences were observed between the TXA and control groups regarding periorbital edema at 24 h (P = .965) and 1 week (P = 1.000) postoperatively. Additionally, periorbital ecchymosis showed no substantial difference between the groups at 24 h (P = .597) or 1 week (P = .063). Intraoperative bleeding was marginally reduced in the TXA group (39.38 ± 23.699 vs 43.13 ± 26.435 mL), although this difference did not achieve statistical significance (P = .506).

The local infiltration of TXA did not lead to a statistically significant reduction in periorbital edema, ecchymosis, or intraoperative bleeding among rhinoplasty patients compared with a placebo. These findings suggest that local infiltration may not provide the same benefits in rhinoplasty procedures as those documented with systemic administration routes.

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