Comparative Efficacy of Desmopressin, Tranexamic Acid, and Phenylephrine in Reducing Bleeding and Improving Surgical Field Quality during Rhinoplasty: A Triple-Blind Randomized Controlled Trial.

Summary

In a triple-blind, four-arm RCT (n=80), desmopressin and tranexamic acid significantly reduced bleeding and improved Boezaart surgical field scores at all measured time points versus control, while phenylephrine showed benefits only early. All three drugs shortened operative time compared with control, with desmopressin and tranexamic acid showing the most consistent effects.

Key Findings

• Desmopressin and tranexamic acid reduced bleeding and improved Boezaart surgical field scores at 30, 45, and 90 minutes versus control (p<0.05).
• Phenylephrine improved bleeding and field quality only at early time points (15–30 or 30–45 minutes).
• All intervention groups had shorter operative times compared with control (p<0.05), with no baseline imbalances.

Clinical Implications

Consider desmopressin or tranexamic acid as first-line adjuncts for bleeding control and surgical field optimization in rhinoplasty, with phenylephrine reserved for short-duration benefit. Protocols should incorporate dosing and monitoring for safety.

Limitations

• Single-center, modest sample size (n=80) limits generalizability.
• Short-term endpoints; no postoperative ecchymosis/edema or bleeding complications reported beyond intraoperative period.

Future Directions

Define optimal dosing and timing, evaluate combination regimens, and test postoperative outcomes (ecchymosis, edema, transfusion, revision) across procedure complexity in multicenter trials.