Rhinoplasty edema can be reduced with at least 1 dose of intravenous steroid intervention without significant differences between betamethasone, methylprednisolone, and dexamethasone, according to findings published in Journal of Plastic, Reconstructive & Aesthetic Surgery.
Researchers sought to determine the most appropriate steroids for use in the perioperative period of rhinoplasty to prevent postoperative complications. The primary outcome was postoperative edema. The secondary outcome was postoperative ecchymosis.
They conducted a systematic review and meta-analysis including 18 randomized controlled trials (RCTs) independently reviewed by 2 study authors after searching the Cochrane Central Register of Controlled Trials, Embase and PubMed databases up to June 2022. The included RCTs were published between 1952 and 2018 and included 4 types of steroids (dexamethasone, betamethasone, triamcinolone, methylprednisolone). Patients underwent rhinoplasty or septorhinoplasty, and the researchers compared perioperative intravenous steroids, as well as steroid use versus no use, and included patients with postoperative blood loss, ecchymosis, and edema.
Studies with non-steroidal groups taking any steroid-like anti-inflammatory drugs. that included non-steroidal adjunctive interventions, relied on injection strategies or using the same types of steroids at varying temperatures. and studies not published in English were excluded. The revised risk of bias tool was used to assess the quality of the included RCTs. Most of the included studies had a low risk of bias, 2 had a high risk and 1 had some concerns (conclusions with small differences that do not change decision-making are derived from confidence intervals and prediction intervals).
“
At least one dose of intravenous steroid intervention will be recommended during the perioperative period of rhinoplasty.
Patients were assessed on postoperative days 1, 3, and 7. The random-effects model was used to perform all analyses.
Data on the assessment of edema on postoperative day 1 were available in 8 studies. The researchers found that swelling was significantly reduced on postoperative day 1 with methylprednisolone (standard mean difference [SMD]0.412; 95% CI, 0.019-0.805) and dexamethasone (SMD, 0.581; 95% CI, 0.226-0.937) versus placebo. There was no significant reduction in postoperative edema with betamethasone versus placebo (SMD, 0.470; 95% CI, -0.370 to 1.310). None of these steroids showed significant effect differences for edema on postoperative day 1.
Data on postoperative day 3 and day 7 edema assessment were available in 5 and 7 studies, respectively. There was no significant difference in efficacy in reducing postoperative edema on day 3 or day 7 with methylprednisolone, dexamethasone or betamethasone compared with placebo and no significant difference between these 3 steroids on day 3 or day 7 in reducing edema .
Data for assessment of ecchymosis on postoperative day 1 were available in 8 studies with methylprednisolone, dexamethasone and betamethasone. There was a significant reduction in postoperative ecchymosis with dexamethasone versus placebo (SMD, 0.540; 95% CI, 0.085-0.995). There was no significant reduction in postoperative ecchymosis versus placebo with betamethasone (SMD, 0.609; 95% CI, -0.400 to 1.618) or methylprednisolone (SMD, 0.430; 95% CI, -0.090 to 0.950). There was no significant difference between these 3 steroids on day 1 in reducing postoperative ecchymosis.
Data for evaluation of ecchymosis on postoperative day 3 and day 7 were available in 5 and 7 studies, respectively. Day 3 postoperative ecchymosis was significantly reduced with methylprednisolone versus placebo, and there was no significant day 3 reduction in postoperative ecchymosis with betamethasone or dexamethasone versus placebo. Postoperative ecchymosis was significantly reduced at day 7 with dexamethasone versus placebo, and there was no significant reduction at day 7 with betamethasone or methylprednisolone versus placebo. There was no significant difference between these 3 steroids on day 3 or day 7 in reducing postoperative ecchymosis.
Limitations of the study include the low-powered sample size.
“At least [1] The dose of intravenous steroid intervention would be recommended in the perioperative period of rhinoplasty,” the researchers wrote. “In terms of reduction of edema and ecchymosis, no significant differences were noted between dexamethasone, methylprednisolone and betamethasone.”
