Epinephrine/Lidocaine Injection Vs. Saline During Endoscopic Sinus Surgery

Abstract

Injection of epinephrine/lidocaine mixture does not produce higher blood levels of epinephrine when compared to saline injection and did not induce any harmful side effects. We postulate that the combination with lidocaine 1% may reduce the patients' stress and thus prevent higher catecholamine levels.

Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery

“…These levels were consistent with the values reported in the literature. 1,3,31 Multiple intrinsic and extrinsic factors, particularly the use of a general anesthetic, contribute to the final recorded blood pressure. However, the lack of significant hypertensive episodes noted in our cohort supports CE's lack of significant impact on systemic vascular parameters-a finding that is in concordance with our lack of complications.…”

Hemostasis in sinus surgery

“…High doses of epinephrine and inadvertent intravenous injection have contrasting effects with life-threatening tachycardia and severe hypertension two well established consequences. Although a recent RCT by Cohen-Kerem et al [32] did show a benefit in the operative field when epinephrine infiltration was used compared to saline, a more recent similarly designed RCT by Javer et al [35] did not replicate these findings. In fact, in this study a statistically significant increase in MABP was noted in the epinephrine study arm, despite the absence of obvious intravenous infiltration.…”

“…Local infiltration with epinephrine containing local anesthetic agents is thought to improve hemostasis through both their local vasoconstrictor action as well as their anesthesia of nasal mucosa against surgical stimulation [32].…”

Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis

“…Hemostatic efficacy of local anesthetic with vasoconstrictor was demonstrated in a study that showed decreased bleeding when lidocaine/epinephrine was injected as compared to injection of placebo ( P < 0.05) [39]. However, intraoperative estimated blood loss was not significantly different between the anesthetic/epinephrine and control groups ( P > 0.05) [29, 30].…”

“…Arterial pressure and heart rate were affected immediately after injection of lidocaine/epinephrine but were not elevated over the normal range [39]. Another study found no significant difference between bupivacaine/epinephrine and control groups ( P > 0.05) [41].…”