# Effectiveness of Bleeding Control Methods in Rhinoplasty: A Systematic Review and Meta-Analysis

## TL;DR

This study reviews and compares methods to control bleeding during nose surgery, finding that some drugs and positioning techniques are effective.

## Contribution

The study provides a meta-analysis comparing multiple bleeding control methods in rhinoplasty for the first time.

## Key findings

- Tranexamic acid and steroids were most effective in reducing intraoperative bleeding.
- Patient positioning also significantly reduced bleeding, though less than pharmacological methods.
- Desmopressin showed a positive trend but was not statistically significant.

## Abstract

One of the most common complications of rhinoplasty and septorhinoplasty is intraoperative bleeding, which poses challenges for both surgeons and patients. This systematic review and meta-analysis aimed to evaluate the effectiveness of various bleeding control methods in rhinoplasty and septorhinoplasty surgeries.

This study conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in reputable international databases to identify relevant studies. Ultimately, 16 randomized controlled trials (RCTs) with 933 patients were included in the analysis. The bleeding control methods evaluated included tranexamic acid (TXA), desmopressin, steroids, magnesium sulfate, clonidine, remifentanil, and patient positioning (reverse Trendelenburg position). Data were combined using meta-analysis methods in STATA version 17, and the standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated to assess the effects of the methods. The results showed that TXA (SMD: −1.31; 95% CI: −2.01 to −0.62) and steroids (SMD: −1.07; 95% CI: −1.70 to −0.43) had the most significant impact on reducing bleeding. Patient positioning also showed a considerable effect (SMD: −0.65; 95% CI: −1.01 to −0.30), and desmopressin had a positive impact (SMD: −1.53; 95% CI: −3.12 to 0.06), though this effect was not statistically significant. This study demonstrates that pharmacological and non-pharmacological interventions, such as TXA and patient positioning, can significantly reduce intraoperative bleeding. However, further studies with larger sample sizes and standardized designs are recommended for magnesium sulfate, clonidine, and remifentanil methods.

Level of Evidence I.