Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine‐containing solutions of lidocaine produces profound hypotension

Yang, Jianjun; Li, W. Y.; Jil, Q.; Wang, Z. Y.; Sun, Jianfang; Wang, Q. P.; Li, Z. Q.; Xu, Jianguo

doi:10.1111/j.1399-6576.2005.00869.x

Cited by 43 publications

(41 citation statements)

References 16 publications

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“…Thus, the transnasal local anesthetic infiltration may cause systemic absorption of the local anesthetics, and thereby analgesic effects [12]. Besides, the combined effect of local anesthetics and general anesthesia in inducing hypotension may minimize the risk of surgical complications and stabilize hemodynamics [2]. In our study, the decrease in HR in the block groups is obviously reported; however, MAP remained high in bupivacaine group after the operation.…”

Section: Discussionmentioning

confidence: 78%

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Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

Kesimci¹,

Öztürk²,

Berçin

et al. 2011

Eur Arch Otorhinolaryngol

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The aim of this study was to evaluate the analgesic efficacy of sphenopalatine ganglion block performed under general anesthesia in patients undergoing functional endoscopic sinus surgery (FESS) with operative blood loss and postoperative complications (headache, visual disturbances, nausea, vomiting, sore throat, swallow difficulty). Forty-five consenting patients were randomized to receive bilateral sphenopalatine ganglion block with saline (Group S, n = 15), bupivacaine 0.5% (Group B, n = 15), or levobupivacaine 0.5% (Group L, n = 15) immediately following induction of general anesthesia. Esmolol was given during the intraoperative period for a 20% increase in arterial mean pressure or heart rate. Postoperative pain scores were checked on arrival at the postanesthesia care unit, 2, 6, and 24 h after surgery and diclofenac was administered intramuscularly for pain score ≥ 4. A statistically significant reduction was present in postoperative Visual Analog Scale scores between Group S and the block Groups B and L (p < 0.05). In Group L and B, fewer patients required additional analgesics in the postoperative 24 h (p < 0.0001). The comparison of postoperative complications was not statistically significant among the groups (p > 0.05). Sphenopalatine ganglion block with bupivacaine or levobupivacaine improved postoperative analgesia associated with better surgeon and patient satisfaction after FESS.

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Section: Discussionmentioning

confidence: 78%

“…However, it is associated with complications such as bleeding and postoperative pain [2]. It is stated frequently that the combination of a peripheral nerve block with general anesthesia (GA) may be effective to limit these drawbacks [3].…”

Section: Introductionmentioning

confidence: 99%

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

Kesimci¹,

Öztürk²,

Berçin

et al. 2011

Eur Arch Otorhinolaryngol

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“…Skin, mucosa, as well as kidney arterioles display vasoconstriction on account of a-receptor predominant activation. Low concentrations of adrenaline lead to preferential b2 receptor activation leading to vasodilatation in bronchiolar smooth muscle while increased ranges activate a-receptor-mediated vasoconstriction in vascular smooth muscle [5]. Infiltration of low-dose adrenaline leads to short-term significant hemodynamic alterations, decrease in blood pressure with a slightly increased heart rate during nasal surgery under general anesthesia [6].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Effects of Topical Adrenaline During Septoplasty

Günel

Sarı

Eryılmaz

et al. 2014

Indian J Otolaryngol Head Neck Surg

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Vasoconstrictors agents is used in septal surgery, in attempt to improve haemostasis and thereby improve the surgical field. We aimed to compare the effect of lignocaine with adrenaline injection and alone lignocaine injection with topical adrenalin on perioperative hemodynamic effect, hemorrhage and postoperative pain. Patients undergoing surgery were randomised into two groups: group I in whom infiltration was performed with lignocaine (2 %) with adrenaline (1:100,000), group II in whom infiltration was performed with lignocaine (2 %) injection with topical adrenalin application (1:10,000). The two groups were matched by age, sex, body weight, preanesthesia blood pressure, heart rate, oxygen pressure and hemorrhage. The hemostatic effects postoperative pain in each group were analyzed. No statistically significant differences in operation time, hemodynamic effect, and intraoperative blood loss were reached between the two groups of patients (p [ 0.05). But also group I had significantly better pain scores versus control group in the 2nd, 4th, 6th postoperative hours (p \ 0.05). We suggest that the use of adrenaline infiltration during septal surgery is unnecessary and may subject the patient to the risk of cardiogenic side-effects of systemic absorption.

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“…10,[12][13][14][15] Although these effects are of significant concern, they are largely the result of intravascular injection and there is limited literature on the safety of topical CE use or the optimal dose. 11,[16][17][18][19] One study concluded that topical CE use was safe in sinus surgery when combined with avoidance in patients with comorbid cardiac disease. 20 An additional practical concern with the use of CE arises from the potential for the masking of arterial bleeding, which may manifest postoperatively after the vasoconstriction has resolved.…”

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confidence: 98%

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

Korkmaz

Yao

Korkmaz

et al. 2015

Int Forum Allergy Rhinol

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Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine‐containing solutions of lidocaine produces profound hypotension

Abstract: Local infiltration of low-dose epinephrine causes temporary significant hemodynamic changes particularly a marked decrease in BP during FESS under general anesthesia.

Cited by 43 publications

References 16 publications

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

Role of sphenopalatine ganglion block for postoperative analgesia after functional endoscopic sinus surgery

Hemodynamic Effects of Topical Adrenaline During Septoplasty

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

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