Local anaesthetic with vasoconstrictor combinations in septal surgery

Local anaesthetic with vasoconstrictor combinations are often used to reduce bleeding and hence improve the operating field in septal surgery. Two commonly used combinations are lignocaine with adrenaline and prilocaine with felypressin (citanest with octapressin). Most surgeons prefer to use lignocaine with adrenaline but because of the risks of cardiac dysrhythmias when used with halothane anaesthetists prefer prilocaine with felypressin. In a trial with lignocaine 2 per cent and adrenaline 1 in 200,000 against prilocaine 3 per cent and felypressin 0.03 international units/ml in 18 patients undergoing septal surgery with local anaesthesia alone there was significantly less blood loss in the lignocaine with adrenaline group, p less than 0.01. The mean blood loss in the adrenaline group was 7.5 ml. and 32.7 ml. with felypressin. Both combinations were equally effective in producing adequate local anaesthesia. It is concluded that lignocaine with adrenaline is superior to prilocaine with felypressin in achieving a dry operating field in septal surgery under local anaesthesia.