The Role of Perioperative Dexamethasone and Tranexamic Acid in Reducing Edema and Controlling Bleeding in Open Rhinoplasty.

OBJECTIVE

This study aimed to evaluate the effects of intravenous dexamethasone and tranexamic acid (TXA), used alone and in combination, on perioperative bleeding and postoperative edema and ecchymosis in rhinoplasty.

METHODS

In this prospective, randomized controlled trial, patients undergoing open rhinoplasty with piezoelectric-assisted osteotomy were divided into 3 groups: group 1: Combination of IV dexamethasone and TXA, group 2: IV dexamethasone only, group 3: IV TXA only. Periorbital edema and ecchymosis were assessed on postoperative days 1, 3, and 7 using standardized grading. Intraoperative blood loss and mean arterial pressure (MAP) were recorded.

RESULTS

Group 1 showed significantly lower edema scores than group 3 on postoperative day 3, suggesting a stronger anti-inflammatory effect when dexamethasone was included. By day 7, edema had significantly decreased only in group 1, indicating a prolonged effect with combination therapy. No significant differences in ecchymosis were observed between the groups on any postoperative day. Intraoperative bleeding was highest in group 1, possibly due to lower MAP at the beginning of surgery. No adverse effects were reported.

CONCLUSION

The combination of IV dexamethasone and TXA is more effective in controlling postoperative edema than either agent alone. While bleeding was slightly higher with combination therapy, it did not increase ecchymosis. Both agents are safe and may enhance recovery when used together in rhinoplasty.