The effect of topical epinephrine 1:1000 with and without infiltration of 1% lidocaine with epinephrine 1:100, 000 on endoscopic surgical field visualization: a double‐blind randomized controlled study. Issue 2 (31st October 2019)

• Record Type: Journal Article
• Authors: Tangbumrungtham, Navarat; Hwang, Peter H.; Maul, Ximena; Borchard, Nicole A.; Dholakia, Sachi S.; Patel, Zara M.; Nayak, Jayakar V.; Choby, Garret
• Is Part Of: International forum of allergy & rhinology. Volume 10:Issue 2(2020:Feb.)
• Page Start: 147
• Page End: 152
• Publication Date: 2019-10-31
• Subjects: endoscopic sinus surgery -- surgical field grading scale -- lidocaine -- epinephrine -- estimated blood loss -- visualization -- bleeding -- duration of surgery; 617.51005
• DOI: 10.1002/alr.22468
• Languages: English
• ISSNs: 2042-6976

Abstract

Abstract : Background: The objective of this study is to determine whether the infiltration of 1% lidocaine with 1:100, 000 epinephrine in addition to topical application of 1:1000 epinephrine significantly improves surgical field grading scale score over topical 1:1000 epinephrine alone. Methods: A prospective, double‐blind, randomized, controlled study was performed of 40 patients undergoing bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Patients were enrolled and randomly assigned to receive infiltration with 1% lidocaine with 1:100, 000 epinephrine on 1 side of the nasal cavity vs plain saline on the other side in preparation for ESS. Both groups received topical application of 1:1000 epinephrine. Surgical videos were recorded and Wormald surgical field grading scale was assigned by 2 blinded reviewers. The number of extra 1:1000 epinephrine pledgets used during the surgery, estimated blood loss, and surgical duration were also recorded. Results: There were no statistically significant differences in Wormald surgical field grading scale, number of extra pledgets used, or estimated blood loss between the nasal cavity side infiltrated with 1% lidocaine with 1:100, 000 epinephrine in comparison to infiltration with saline. The side infiltrated with 1% lidocaine with 1:100, 000 epinephrine had a reduced operative time compared to the side infiltrated with saline ( p = 0.002). There were no differences in postoperative bleeding from questionnaire completed by patient at the first postoperative visit. Conclusion: Addition of infiltration of 1% lidocaine with epinephrine 1:100, 000 to topical application of epinephrine 1:1000 for preparation of ESS does not significantly improve surgical field of view compared to topical epinephrine alone.