Epinephrine/Lidocaine Injection Vs. Saline During Endoscopic Sinus Surgery

Authors

  • Raanan Cohen-Kerem MD,

    Corresponding author
    1. From the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. From the the Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
    3. From the St. Joseph's Health Center, and the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Send correspondence to Raanan Cohen-Kerem, MD, Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, 7 Michal St., Haifa 34362, Israel
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  • Stephen Brown MD, FRCPC,

    1. From the the Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Luis Velazquez Villaseñor MD,

    1. From the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. From the the Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
    3. From the St. Joseph's Health Center, and the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Ian Witterick MD, MSc, FRCSC

    1. From the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
    2. From the the Department of Anesthesia, Mount Sinai Hospital, Toronto, Ontario, Canada
    3. From the St. Joseph's Health Center, and the Department of Otolaryngology–Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Editor's Note: This Manuscript was accepted for publication February 14, 2008. This study was presented at the American Rhinologic Society meeting, San Diego, California, U.S.A., April 26–27, 2007.

Abstract

Objectives: To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.

Design: A double-blind randomized controlled trial.

Methods: Patients were assigned into two groups and were injected with either epinephrine 1:100,000 and lidocaine 1% or saline alone during endoscopic nasal surgery under general anesthesia. Pledgets soaked in epinephrine 1:1,000 were used throughout the procedure in both groups. Hemodynamic measurements and catecholamine blood levels were obtained.

Results: Ten patients were randomized to the epinephrine group and 12 to the saline group. We were able to measure epinephrine and norepinephrine levels following injection in all patients. Epinephrine levels were similar in both groups immediately after injection; however, 15 minutes following injection, epinephrine was significantly higher in saline-injected patients. Mean arterial pressure and heart rate were affected by epinephrine and norepinephrine levels immediately after injection but were never elevated over the normal range. Heart rate was higher (P < .05) in the saline injected group than in the epinephrine group throughout the measurement period. The surgeons believed that the surgical field was bloodier in saline-injected patients (P < .05) however objective estimation of blood loss showed no difference.

Conclusions: 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.

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