title: Epinephrine/Lidocaine injection vs. saline during endoscopic sinus surgery.
abstract: OBJECTIVE
  To assess the safety and effectiveness of an epinephrine/lidocaine mixture administered by injection versus epinephrine administered topically and to learn its pharmacokinetics following administration to the nasal mucosa.
  
  
  METHODS
  A double-blind randomized controlled trial.
  
  
  METHODS
  Patients were assigned into two groups and were injected with either epinephrine 1:100,000 and lidocaine 1% or saline alone during endoscopic nasal surgery under general anesthesia. Pledgets soaked in epinephrine 1:1,000 were used throughout the procedure in both groups. Hemodynamic measurements and catecholamine blood levels were obtained.
  
  
  RESULTS
  Ten patients were randomized to the epinephrine group and 12 to the saline group. We were able to measure epinephrine and norepinephrine levels following injection in all patients. Epinephrine levels were similar in both groups immediately after injection; however, 15 minutes following injection, epinephrine was significantly higher in saline-injected patients. Mean arterial pressure and heart rate were affected by epinephrine and norepinephrine levels immediately after injection but were never elevated over the normal range. Heart rate was higher (P < .05) in the saline injected group than in the epinephrine group throughout the measurement period. The surgeons believed that the surgical field was bloodier in saline-injected patients (P < .05) however objective estimation of blood loss showed no difference.
  
  
  CONCLUSIONS
  Injection of epinephrine/lidocaine mixture does not produce higher blood levels of epinephrine when compared to saline injection and did not induce any harmful side effects. We postulate that the combination with lidocaine 1% may reduce the patients' stress and thus prevent higher catecholamine levels.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. nrkerem@hotmail.com
authors.forename: Raanan
authors.initials: R
authors.lastname: Cohen-Kerem
authors.forename: Stephen
authors.initials: S
authors.lastname: Brown
authors.forename: Luis Velazquez
authors.initials: LV
authors.lastname: Villaseñor
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D016063:Blood Loss, Surgical; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods*; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006488:Hemostasis, Surgical; D006801:Humans; D007267:Injections; D007279:Injections, Subcutaneous; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery*; D009638:Norepinephrine / Q000097:blood; D012008:Recurrence; D012852:Sinusitis / Q000601:surgery*
chemical_list: D008012:Lidocaine; D009638:Norepinephrine; D004837:Epinephrine