Cocaine, Tetracaine / Oxymetazoline and Ropivacaine / Oxymetazoline in Functional Endoscopic Sinus Surgery Pages 7-12

S.A.S. van den Heuvel1>, B.C.F. van den Borne2, J.A.M. Engel2 and M.M.J. Snoeck3

1Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center Nijmegen, The Netherlands; 2Department of Otorhinolaryngology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; 3Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

DOI: https://doi.org/10.12970/2308-7978.2019.07.02

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Abstract: Objective: Endonasal cocaine gauzes are applied during functional endoscopic sinus surgery (FESS) for their combined analgesic and decongestive properties. Seeking an alternative for cocaine, tetracaine/oxymetazoline, and ropivacaine/oxymetazoline were investigated for their efficacy and safety during FESS.

Methods: Over 18 months a double-blinded randomised prospective intervention study was conducted. Ninety patients were allocated to 3 groups that received a blinded 5 ml solution containing cocaine 5 %, tetracaine 0.8 % plus oxymetazoline 0.02 % or ropivacaine 0.8% plus oxymetazoline 0.02 %. Two Ear Nose Throat surgeons participated and evaluated preprocedural decongestion, postoperative decongestion and haemostasis according to a numeric rating scale (NRS, 0 – 10). Postoperative pain scores (NRS) registered until discharge. Secondary outcomes were intraoperative blood loss, perioperative hemodynamics, postoperative bandage changes, morphine consumption, nausea and vomiting.

Results: No significant difference was observed between groups for preprocedural decongestion (p = 0.72) and postoperative decongestion (p = 0.48) and haemostasis (p = 0.44). Mean postoperative pain scores were low (NRS 1.00, SD 1.15) without significant difference (p = 0.55).

Conclusion: Based on the results of this study we can recommend tetracaine / oxymetazoline or ropivacaine / oxymetazoline as a safe and effective topical agent for FESS that can replace cocaine.

Keywords: Nasal cavity, nasal septum deviation. Read more