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

Zamani MR, Abbasi R, Imani B, Karimi A, Najafi Vosough R.

PubMed 41028612 Publisher (DOI)Free full text (PMC)

What this paper says

In an 80-patient triple-blind trial, desmopressin and tranexamic acid reduced bleeding and improved the surgical field throughout rhinoplasty, phenylephrine helped only in the first 30-45 minutes, and all three shortened operating time.

Overview

Bleeding during rhinoplasty obscures the field and adds to bruising afterwards. The Iranian authors randomised 80 patients aged 18-50 into four equal groups (tranexamic acid, phenylephrine, desmopressin, control), measured field quality with the Boezaart scale and blood loss by weighing gauze and suction fluid at 15, 30, 45 and 90 minutes. Registered IRCT20240712062409N1.

Sections of note

Groups matched on demographics and laboratory values.
Desmopressin and tranexamic acid: less bleeding than control at 30, 45 and 90 minutes (p < 0.05).
Phenylephrine: less bleeding only at 30 and 45 minutes.
Field quality better with desmopressin and tranexamic acid at all time points; phenylephrine only at 15 and 30 minutes.
All three drugs shortened operative time versus control (p < 0.05). Level of Evidence I.

What it means for a patient

Drugs given around surgery can reduce bleeding, which typically means less bruising and a shorter operation.
Desmopressin and tranexamic acid worked for the whole procedure; phenylephrine wore off.
The trial measured bleeding, not final appearance; ranked effectiveness is the authors' interpretation.

Why this paper matters

It is a head-to-head randomised comparison of the three common haemostatic drugs in rhinoplasty. Limits: 20 per group, single centre, no postoperative bruising outcomes reported in the abstract.

Terms

Desmopressin (DDAVP): a hormone analogue that boosts clotting factors.
Tranexamic acid (TXA): a drug that stabilises blood clots.
Phenylephrine: a vasoconstrictor that narrows blood vessels locally.
Boezaart scale: a 0-5 surgeon rating of bleeding in the surgical field.
Triple-blind: patient, surgeon and assessor all unaware of group allocation.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Rhinoplasty, a popular cosmetic surgery, often faces intraoperative bleeding, which reduces surgical visibility and increases postoperative periorbital edema and ecchymosis. This study compared the effects of desmopressin, tranexamic acid, and phenylephrine on reducing bleeding and improving surgical field quality in rhinoplasty.

Methods: In this triple-blind clinical trial, 80 patients aged 18-50 undergoing rhinoplasty were randomly divided into four groups: tranexamic acid, phenylephrine, desmopressin, and control. Surgical field quality was assessed using the Boezaart scale, and bleeding volume was measured by weighing blood-soaked gauze and suction fluid. Data were recorded at 15, 30, 45, and 90-minute intervals and analyzed using SPSS 24.

Results: There were no significant differences in demographic or laboratory characteristics among the groups (p > 0.05). The desmopressin and tranexamic acid groups had less bleeding than the control group at 30, 45, and 90 min (p < 0.05), while phenylephrine was effective only at 30 and 45 min (p < 0.05). The quality of the surgical field was better in the desmopressin and tranexamic acid groups at all time points (p < 0.05), but phenylephrine showed improvement only at 15 and 30 min (p < 0.05). Additionally, all intervention groups had a shorter operative time duration compared to the control group (p < 0.05).

Conclusion: Desmopressin, tranexamic acid, and phenylephrine, in that order, were the most effective in reducing bleeding and improving surgical field quality. Additionally, these drugs reduced operative time, highlighting their potential to benefit patients and facilitate surgical procedures for surgeons.

Trial Registration: IRCT20240712062409N1 LEVEL OF EVIDENCE I: 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).