Infiltration with lidocaine and adrenaline instead of normal saline does not improve the septoplasty procedure

Abstract

The aim of this study was to determine whether infiltration of local anesthetics with adrenaline improved septoplasty procedure when compared to normal saline. Eight-two patients undergoing septoplasty were randomized into two groups. In group 1, septal mucoperichondrium was infiltrated with lidocaine with adrenaline, and normal saline was used in group 2. Presence of intra-operative septal mucosal injuries, the amount of bleeding, arterial blood pressure, operation time as well as the quality of the surgical field and the convenience of finding the correct surgical plane as determined by the surgeon using a 5-point scale were compared between two groups. There were no significant differences for the amount of blood loss, mean arterial pressure, operation time, or scores for convenience of finding the correct surgical plane between the two groups. There was no significant difference for intra-operative simple (P = 0.631) and total (simple+severe) (P = 0.649) septal mucoperichondrial injuries between groups 1 and 2, either. However, severe mucoperichondrial injury rate was higher in the patients infiltrated with lidocaine and adrenaline (P = 0.026), and the quality of the surgical field was worse in the patients injected with normal saline (P = 0.0179). Infiltration of septal mucoperichondrium with lidocaine and adrenaline instead of normal saline was not advantageous in terms of objective parameters tested, including bleeding amount and duration of surgery as well as the of the total mucosal injury rate in septoplasty procedure.

Septoplasty: Comparison of adrenaline with normal saline as submucoperichondrial infiltration solution.

“…In Group I there was very little bleed so surgical plane was readily accessed but Group II Patients experienced frequent surgical field flooding which made surgical access difficult and time taking. This finding was totally in contrast to some of the previous studies 4,6 which showed that that there is no significant difference between adrenaline and normal saline. But in these studies by Mahilravi Thevasagayam et al and Volkan Gungor et al the concentration of adrenaline used was different and more so it was used in combination with lignocaine.…”

“…Rationale behind using adrenaline and normal saline in this study is that they are easily available, cost effective and already being used in most hospitals all over the world [4][5][6] but in various combinations. Variables used to assess the efficacy of submucoperichondrial infiltration solutions are both subjective as well as objective which can gauge the effectiveness of these solutions accurately.…”

“…Different surgeons prefer different solutions for submucoperichondrial infiltration to achieve bloodless surgical field 4 and hydrodissection 5 so that mucoperichondrial injury can be avoided and submucoperichondrial plane can be located easily thus ultimately shortening the duration of surgery. Some of the most common solutions used to achieve these goals are submucoperichondrial infiltration of 2% lignocaine with adrenaline 6,7 , adrenaline alone in different concentrations 8 , 2% tetracaine 9 , 4% articaine with adrenaline 9 and even normal saline. 6 There is no consensus 4 on any single solution for infiltration.…”

“…Some of the most common solutions used to achieve these goals are submucoperichondrial infiltration of 2% lignocaine with adrenaline 6,7 , adrenaline alone in different concentrations 8 , 2% tetracaine 9 , 4% articaine with adrenaline 9 and even normal saline. 6 There is no consensus 4 on any single solution for infiltration. This study aims to evaluate subjectively (mucoperichondrial injury and convenience of finding the surgical plane) as well as objectively (duration of surgery) some of the variables in this context.…”

Easy Recognition of Caudal Lower Cartilage Rim Localization for Marginal Incision in Tumescent Rhinoplasty

“…Saline tumescence could be consider as the reference solution injected, but in our patients we used lidocaine with vasoconstrictor as described above. Gungor et al [10] denied the benefits of anesthetic tumescent rhinoplasty. However, in his study he concludes that there was no benefits in terms of bleeding decrease or mucosal injury prevention, in our opinion it concedes us the possibility to do a complete rhinoplasty only with local anesthetics, which is impossible otherwise if normal saline is only injected.…”