Impact of Topical Tranexamic Acid on Bleeding Control in Rhinoplasty

Background: 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. Methods: 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. Results: 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. Conclusion: 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.