The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial

Overview

The lining of the nose has a rich blood supply and rhinoplasty is performed in a narrow space, so bleeding obscures the surgeon's view. The authors randomly assigned patients to three table positions to test whether simply tilting the patient head-up reduces blood loss and improves the surgeon's working conditions.

Sections of note

• Randomised controlled trial of 71 patients having elective rhinoplasty.
• Group 1: 23 patients operated flat on their back, in the supine position.
• Group 2: 28 patients operated at a 15 degree head-up tilt.
• Group 3: 20 patients operated at a 20 degree head-up tilt.
• There were statistically significant differences between the groups in both surgeon satisfaction and the amount of bleeding during surgery.
• Bleeding was significantly higher and surgeon satisfaction lower in the flat group than in either tilted group. The authors conclude 15 degrees gives optimum conditions, reducing bleeding while remaining comfortable for the surgeon. Level of evidence 1.

What it means for a patient

• Table position is a free intervention requiring no drug and no equipment.
• Less bleeding gives the surgeon a clearer view of the cartilage being shaped.
• The steeper 20 degree tilt was not reported as better than 15 degrees, and the authors favour the lesser tilt on working comfort.
• 71 patients at one centre, and the abstract gives no actual blood loss volumes, no p values and no measure of how surgeon satisfaction was scored, so the size of the effect cannot be read from it.

Why this paper matters

Bleeding control in rhinoplasty is usually approached with drugs, local anaesthetic containing adrenaline, or lowered blood pressure, each with its own risks. Positioning carries none. A randomised design on a simple variable is unusual in this literature. Whether reduced bleeding translates into better results is not measured here.

Terms

• Intraoperative bleeding: blood loss occurring during the operation.
• Supine position: lying flat on the back.
• Reverse Trendelenburg position: the operating table tilted so the head is higher than the feet.
• Mucosa: the moist lining of the inside of the nose.
• Randomised controlled trial: a study assigning patients to groups by chance for fair comparison.
• Level of evidence 1: the strongest tier, from well-conducted randomised trials.