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A Randomized Clinical Trial

Ali Moshaver, MSc, MD, FRCSC; Denny Lin, MD, FRCSC; Ruxandra Pinto, PhD; Ian J. Witterick, MD, MSc, FRCSC

Arch Otolaryngol Head Neck Surg. 2009;135(10):1005-1009.

Objective  To assess the hemodynamic and hemostatic effects of 2 different concentrations of epinephrine in local anesthetic used during functional endoscopic sinus surgery (FESS). Injection of local anesthetic containing epinephrine during endoscopic sinus surgery, while providing hemostasis, has been associated with cardiac adverse effects such as tachycardia, hypertension, as well as arrhythmias.

Design  Double-blind, randomized clinical trial.

Setting  Tertiary referral center.

Patients  A total of 140 patients undergoing FESS randomly divided into 2 groups, with group 1 receiving lidocaine hydrochloride, 2%, with 1:100 000 epinephrine and group 2, lidocaine, 2%, with 1:200 000 epinephrine.

Main Outcome Measures  Baseline and postinjection hemodynamic parameters were recorded at 1-minute intervals for 5 minutes. Patient demographics, the extent of surgery, and the presence of polyps were recorded in both groups. Hemodynamic and hemostatic parameters and intraoperative blood loss were compared.

Results  Significant hemodynamic fluctuations were noted following injection of lidocaine, 2%, with 1:100 000 epinephrine (group 1). Increases in heart rate and systolic, diastolic, and mean arterial blood pressure were noted in group 1 patients. The increase was found to be significant (P < .001) in the first and second minutes after injection and decreased to baseline level by the fifth minute. This fluctuation was not noted in group 2 patients, who received lidocaine, 2%, with 1:200 000 epinephrine. Using a standardized scale to assess surgical bleeding, no statistical difference in the 2 groups was observed (P > .05).

Conclusion  Submucosal injection of lidocaine, 2%, with 1:200 000 epinephrine during FESS does not lead to hemodynamic fluctuations or increased intraoperative bleeding compared with lidocaine, 2%, with 1:100 000 epinephrine.

Trial Registration  clinicaltrials.gov Identifier: NCT00852410

Author Affiliations: Department of Otolaryngology, St Joseph's Health Centre, University of Toronto, Toronto, Ontario, Canada. Dr Moshaver is now with the Department of Surgery, Penticton Regional Hospital, Penticton, British Columbia, Canada.

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