Impact of Topical Tranexamic Acid on Bleeding Control in Rhinoplasty

Hemorrhage during rhinoplasty may impair the surgeon's visibility. Our objective was to examine the impact of subcutaneously administered Tranexamic acid (TXA) on bleeding during rhinoplasty.

A three-blind randomized clinical trial including 60 patients undergoing nose surgery was conducted to compare the effects of two different anesthetic solutions on surgery results. The control group received a solution consisting of 5 cc of 2% lidocaine and 0.5 cc of epinephrine 1/100000, and the TXA group received a solution containing 5 ml of 2 lidocaine, 0.25 cc of epinephrine 1/100000 and 4.75 cc of 10% TXA. To achieve a total injection volume of 10 ml in both groups, distilled water was added. Bleeding rate, hemodynamic parameters, surgeon satisfaction and overall quality of the surgical field were evaluated.

The hemodynamic parameters exhibited no notable differences between the two groups throughout the study period (P value > 0.05). The volume of bleeding observed in the TXA group was marginally greater than that in the control group (P value=0.061). Additionally, there were no significant variations in the quality of the surgical field or the satisfaction levels of the surgeon between the two groups.

In the TXA group, there was no increase in bleeding despite using a low concentration of epinephrine. Consequently, it is recommended that an injectable formulation of TXA containing a reduced concentration of epinephrine be used in surgical procedures where the use of high-concentration epinephrine is contraindicated, such as in patients with cardiovascular disease.