Comparing the preventive effects of tranexamic acid, dexmedetomidine and nitroglycerin on bleeding rate and visual field during rhinoplasty

Abstract

Introduction: In rhinoplasty surgeries, achieving a bloodless surgical field is imperative for optimal visibility. Preventive measures are crucial to minimize bleeding during the procedure. As no previous study has compared the efficacy of tranexamic acid, dexmedetomidine, and nitroglycerin in preventing intraoperative bleeding and enhancing the surgical field's quality during septorhinoplasty, this study aims to assess and compare the effectiveness and safety of administering these agents. Methods: The randomized, double-blind clinical trial included 60 septorhinoplasty candidates at Imam Reza Hospital. Patients received either dexmedetomidine, tranexamic acid, or nitroglycerin intravenously. Surgical parameters, hemodynamic status, surgical vision quality, and surgeon satisfaction were recorded and compared. Results: Dexmedetomidine group exhibited the highest bleeding volume (378.41±59.55 cc), significantly more than nitroglycerin (241.78±36.03 cc) and tranexamic acid (226.44±41.57 cc). The tranexamic acid group had the highest number of cases with fully controlled bleeding and surgeon satisfaction, while the dexmedetomidine group had the lowest. Minor bleeding during surgery was significantly higher in the tranexamic acid group and lowest in the dexmedetomidine group. Very severe uncontrolled bleeding showed significant differences among the groups.