Comparing the Effect of Intravenous Administration of Magnesium Sulfate and Labetalol on Intraoperative Bleeding, Edema, and Ecchymosis after Rhinoplasty

In rhinoplasty, bleeding reduces the surgeon's vision, so bleeding control is very important. Also, edema and ecchymosis are the most common side effects of rhinoplasty. Many drugs have been used to reduce edema and ecchymosis around the eyes after surgery, but they are not suitable for all patient groups due to some side effects. Administration of magnesium sulfate before or during surgery is approved which can stabilize hemodynamic parameters, especially by reducing blood pressure and heart rate. Labtalol is also a competitive blocker of alpha-1 and beta-adrenergic receptors, which reduces heart rate and blood pressure. The aim of this study was to compare the effect of intravenous magnesium sulfate and labetalol on bleeding during rhinoplasty and also edema and ecchymosis afterwards.

In this double-blind clinical trial, 60 rhinoplasty candidates were randomly assigned to receive either magnesium sulfate or labetalol. Magnesium sulfate infusion was done at 30-50mg/kg before induction of anesthesia and 10-20mg/kg/h during the surgery. Labetalol administration at 1mg/min was done during the surgery. We measured heart rate, bleeding rate, surgeon's satisfaction, postoperative complications, edema, and ecchymosis in both groups. The variables were analyzed in STATA V14 applying t-test, ANOVA, ANCOVA, and Chi-square.

In this study, 86.7% of patients were women. The average bleeding in the labetalol group (50.3±28.5cc) was less than that in the sulfate group (76.7±66.4cc) and this difference was on the borderline of significance (P≤0.05). The surgeon's satisfaction was significantly higher in the labetalol group (P<0.05). Edema (24 hours after the operation) and orthostatic hypotension were significantly lower in the sulfate group (P<0.05). There was no significant difference between the two groups in terms of average heart rate, sore throat, headache, respiratory depression, and ecchymosis rate (P>0.05).

According to this study, magnesium sulfate can be used in rhinoplasty to reduce edema and ecchymosis.