APS Aesthetic Plastic Surgery · 2024

Peroperative Cooling in Rhinoplasty: Does it Differ?

Turhal G, Berber V, Isler E, Gode S.

PubMed 38806826 Publisher (DOI)Free full text (PMC)

What this paper says

In 50 patients randomized to cold or room temperature saline irrigation during rhinoplasty, the cold group had less pain on day 2 and less bruising on day 7.

Overview

Bruising and swelling after rhinoplasty come from bone cutting, dissection under the skin and handling of the skin itself. Swelling of the eyelids can affect vision in the first day and delays return to normal life. The authors compared irrigating the surgical site with cold saline at 0 to 4 degrees against room temperature saline at 20 to 25 degrees throughout the operation.

Sections of note

Design: randomized comparison, 50 patients undergoing open approach primary rhinoplasty at a tertiary academic centre, August 2022 to August 2023. Group 1 received cold saline, group 2 room temperature saline.
Assessment at days 2 and 7 using a visual analog scale plus the SPREE scale for swelling and bruising around the eyes.
Pain on day 2 was significantly lower in the cold group, p less than 0.05, but the groups did not differ on day 7.
Bruising on day 7 was significantly lower in the cold group by both visual analog scale and SPREE, p less than 0.05. SPREE on day 2 was lower but not significant, p equal to 0.061.
The authors state intraoperative bleeding decreased with cold saline, attributing it to narrowing of blood vessels.

What it means for a patient

Cold irrigation reduced early pain and later bruising, using nothing more than chilled saline already present in the operating room.
The effects were modest and appeared at different time points rather than consistently across the recovery.
The reported reduction in bleeding during surgery is stated as an observation, not as a measured outcome with numbers.
Limits: 50 patients, one centre, one surgical approach, assessment only at two time points, and no measurement of the final result.

Why this paper matters

Recovery appearance drives much of the early patient experience, and interventions that cost nothing are worth testing. A randomized comparison of irrigation temperature is a simple, directly actionable question. The effects here are small and inconsistent across time points, so the case is suggestive rather than settled.

Terms

Irrigation: rinsing the surgical field with fluid during an operation.
Saline: sterile salt water used to rinse tissue.
Vasoconstriction: narrowing of blood vessels, which reduces bleeding.
Periorbital: located around the eye.
SPREE scale: the Surgeon Periorbital Rating of Edema and Ecchymosis, a grading tool for swelling and bruising.
Hemostasis: control of bleeding.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

The main causes of ecchymosis and edema are osteotomy (bone manipulation), dissection of subcutaneous tissue, and skin manipulation in the rhinoplasty procedure. Eyelid edema following surgery can potentially affect visual acuity, particularly during the initial twenty-four hours after the procedure. These may also delay the patient's return to their normal social life therefore hampering their quality of life. Various surgical and medical methods have been reported to address these issues. This study aimed to compare the effects of using cold saline (0-4 °C) versus room temperature saline (20-25 °C) irrigation throughout the surgery on postoperative edema, ecchymosis, and pain. Fifty patients who underwent open-approach primary rhinoplasty between August 2022 and August 2023 at a tertiary academic center were included. Fifty patients were randomly divided into two groups depending on using cold saline (0-4 °C) (group 1) or room temperature saline (20-25 °C) (group 2) during surgical site irrigation. Patients were assessed for pain, edema, and bruising using a VAS (Visual Analog Scale) on the second and seventh postoperative days. Visual analog score (VAS) was used for subjective outcome analyses. Each patient scored the severity of their periorbital ecchymosis on day two and seven. Periorbital ecchymosis was also evaluated on the second and seventh postoperative days using the SPREE (Surgeon Periorbital Rating of Edema and Ecchymosis) scale. On the second postoperative day, the VAS pain score in group 1, where cold water was used, was found to be statistically and significantly different from the control group (group 2) (p < 0.05). However, there was no statistically significant difference between both groups when comparing the VAS pain scores on the seventh postoperative day. Regarding the VAS ecchymosis score on the seventh postoperative day, there was a statistically significant difference favoring group 1 (p < 0.05). The SPREE scale data also indicated that group 1 had significantly lower scores on the seventh day (p < 0.05). While the SPREE scores on the second day were lower in group 1 than in group 2, this difference did not reach statistical significance (p = 0.061). The findings from our study show that cold saline irrigation may contribute to intraoperative hemostasis by inducing local vasoconstriction. We observed that intraoperative bleeding decreased with the use of cold saline. This approach has the potential to improve patient satisfaction and overall quality of life by reducing postoperative ecchymosis without significantly increasing the cost of the surgical procedure.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).