A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema.
BACKGROUND
Both arnica and corticosteroids have been suggested for reducing the postoperative edema and bruising associated with rhinoplasty. This study compared the efficacy of these products following rhinoplasty.


METHODS
Forty-eight primary rhinoplasty patients were randomized into three groups: group P received 10 mg of dexamethasone (intravenously) intraoperatively followed by a 6-day oral tapering dose of methyl-prednisone; group A received arnica three times a day for 4 days; and group C received neither agent and served as the control. Three blinded panelists rated the extent of ecchymosis, the intensity of the ecchymosis, and the severity of the edema.


RESULTS
On postoperative day 2, there were no significant differences in the ratings of extent and intensity of ecchymosis among the groups. There was a significant difference for the edema rating (p < 0.0001), with group C demonstrating more swelling compared with groups A and P. In addition, on postoperative day 8, group P demonstrated a significantly larger extent of ecchymosis (p < 0.05) and higher intensity of ecchymosis (p < 0.01) compared with groups A and C. There were no differences in the magnitude of edema by postoperative day 8 among the three groups. When the differences between day 2 and day 8 ratings were considered, groups A and C exhibited significantly more resolution of ecchymosis by day 8 compared with group P (p < 0.05).


CONCLUSIONS
This study suggests that both arnica and corticosteroids may be effective in reducing edema during the early postoperative period. Arnica does not appear to provide any benefit with regard to extent and intensity of ecchymosis. The delay in resolution of ecchymosis for patients receiving corticosteroids may outweigh the benefit of reducing edema during the early postoperative period.
Totonchi
Ali
A
Cleveland (Lyndhurst), Ohio From the Department of Plastic Surgery, Case Western Reserve University.
Guyuron
Bahman
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018650:Arnica; D004438:Ecchymosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D004487:Edema / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D028321:Plant Preparations / Q000627:therapeutic use*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use*; D011336:Probability; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
D028321:Plant Preparations; D011241:Prednisone