Topical cocaine vs adrenaline in endoscopic sinus surgery: a blinded randomized controlled study.

Area of Science:

• Otolaryngology
• Surgical Innovation
• Anesthesia

Background:

• Optimal surgical field visualization is critical for minimizing complications in functional endoscopic sinus surgery (FESS).
• Intraoperative bleeding significantly impacts surgical field clarity and patient safety.
• Topical vasoconstrictors are commonly used to improve visualization and reduce bleeding during FESS.

Purpose of the Study:

• To compare the efficacy of topical cocaine versus adrenaline in improving surgical field visualization during FESS.
• To assess the impact of topical cocaine and adrenaline on intraoperative bleeding in FESS.

Main Methods:

• A randomized controlled trial involving 37 patients undergoing FESS for chronic rhinosinusitis.
• Nasal sides were randomized to receive either adrenaline or cocaine-soaked patties.
• Surgeons assessed surgical field bleeding using a validated scale, blinded to the vasoconstrictor used.

Main Results:

• No significant difference was observed in mean surgical field visualization scores between cocaine and adrenaline sides (p = 0.24).
• Total intraoperative blood loss was comparable between the two treatment groups (p = 0.43).
• On the cocaine side, correlations were found between surgical field grade, duration of surgery, blood loss, and mean arterial pressure.

Conclusions:

• Topical cocaine and adrenaline provide equivalent surgical field quality during FESS.
• Both agents are suitable for topical decongestion at the commencement of FESS.
• The choice between cocaine and adrenaline can be based on availability and surgeon preference.