Epinephrine/Lidocaine injection vs. saline during endoscopic sinus surgery

Area of Science:

• Anesthesiology and Pain Management
• Otolaryngology - Head and Neck Surgery
• Pharmacology and Toxicology

Background:

• Topical epinephrine is commonly used for vasoconstriction in nasal surgery.
• The safety and pharmacokinetic effects of injectable epinephrine/lidocaine mixtures in nasal surgery are not well-established.
• Understanding catecholamine responses is crucial for patient safety during surgical procedures.

Purpose of the Study:

• To evaluate the safety and efficacy of an injectable epinephrine/lidocaine mixture versus topical epinephrine.
• To determine the pharmacokinetic profile of the epinephrine/lidocaine mixture after nasal mucosal administration.
• To assess hemodynamic and catecholamine level changes during endoscopic nasal surgery.

Main Methods:

• A double-blind, randomized controlled trial was conducted.
• Patients received either an epinephrine (1:100,000) and lidocaine (1%) mixture or saline via injection.
• Topical epinephrine (1:1,000) was used in both groups; hemodynamic and catecholamine levels were monitored.

Main Results:

• Epinephrine levels were similar immediately post-injection but higher in the saline group after 15 minutes.
• Hemodynamic parameters (mean arterial pressure, heart rate) were transiently affected but remained within normal limits.
• Surgeons perceived a bloodier surgical field in the saline group, though objective blood loss was similar.

Conclusions:

• Injectable epinephrine/lidocaine mixture is safe, does not elevate blood epinephrine levels compared to saline, and causes no adverse effects.
• The combination with lidocaine may mitigate patient stress, potentially preventing elevated catecholamine levels.
• Further research could explore the stress-reducing mechanisms of this anesthetic combination in surgical settings.