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Open Access
CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2706-1208
Review Article

Effectiveness of Bleeding Control Methods in Rhinoplasty: A Systematic Review and Meta-Analysis

Authors

  • Mohammad Reza Zamani

    1   Operating Room, Hamadan University of Medical Sciences School of Paramedicine, Hamadan, Iran (the Islamic Republic of) (Ringgold ID: RIN158772)

  • Behzad Imani

    1   Operating Room, Hamadan University of Medical Sciences School of Paramedicine, Hamadan, Iran (the Islamic Republic of) (Ringgold ID: RIN158772)

  • Rohollah Abbasi

    2   Otolaryngology, Hamadan University of Medical Sciences, Hamadan, Iran (the Islamic Republic of) (Ringgold ID: RIN48430)

  • Ashkan karimi

    1   Operating Room, Hamadan University of Medical Sciences School of Paramedicine, Hamadan, Iran (the Islamic Republic of) (Ringgold ID: RIN158772)

  • Samad Moslehi

    3   Biostatistics, Hamadan University of Medical Sciences School of Public Health, Hamadan, Iran (the Islamic Republic of) (Ringgold ID: RIN158770)

Supported by: Vice Chancellor for Research and Technology, Hamadan University of Medical Sciences 140303292677
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One of the most common complications of rhinoplasty and septorhinoplasty is intraoperative bleeding, which poses challenges for both surgeons and patients. This systematic review and meta-analysis aimed to evaluate the effectiveness of various bleeding control methods in rhinoplasty and septorhinoplasty surgeries. This study conducted a systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive search was performed in reputable international databases to identify relevant studies. Ultimately, 16 randomized controlled trials (RCTs) with 933 patients were included in the analysis. The bleeding control methods evaluated included tranexamic acid, desmopressin, steroids, magnesium sulfate, clonidine, remifentanil, and patient positioning (reverse Trendelenburg position). Data were combined using meta-analysis methods in STATA version 17, and the standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated to assess the effects of the methods. The results showed that tranexamic acid (SMD: -1.31; 95% CI: -2.01 to -0.62) and steroids (SMD: -1.07; 95% CI: -1.70 to -0.43) had the most significant impact on reducing bleeding. Patient positioning also showed a considerable effect (SMD: -0.65; 95% CI: -1.01 to -0.30), and desmopressin had a positive impact (SMD: -1.53; 95% CI: -3.12 to 0.06), though this effect was not statistically significant. This study demonstrates that pharmacological and non-pharmacological interventions, such as tranexamic acid and patient positioning, can significantly reduce intraoperative bleeding. However, further studies with larger sample sizes and standardized designs are recommended for magnesium sulfate, clonidine, and remifentanil methods.



Publication History

Received: 10 May 2025

Accepted after revision: 16 September 2025

Accepted Manuscript online:
22 September 2025

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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