Effect of intraoperative injection of 0.25% bupivacaine with 1:200,000 epinephrine on intraoperative blood loss in FESS.
BACKGROUND
This study was designed to compare differences in intraoperative blood loss, mean arterial blood pressure (MABP), and duration of surgery when 0.25% bupivacaine with 1:200000 epinephrine is injected, preoperatively, versus normal saline (NS), during functional endoscopic sinus surgery (FESS).


METHODS
A prospective, double-blind randomized placebo-controlled study was performed. Part I involved 46 patients who were infiltrated with 0.25% bupivacaine with 1:200000 epinephrine on one side of the nose and sterile NS on the other (control). Part II involved 30 patients infiltrated with 0.25% bupivacaine with 1:200000 epinephrine bilaterally and 30 patients with NS bilaterally (control). Patient demographics, preoperative MABP, intraoperative MABP, duration of surgery, and total estimated blood loss (EBL) were recorded for each side (Part I) and case (Part II).


RESULTS
For part I, there were 46 patients (mean age, 49 years), 24 women and 22 men. MABP was 72 mmHg for each side (p = 0.97). Preoperative MABP was 93 mmHg. Duration of surgery was 48 minutes for epinephrine side and 45 minutes for control (p = 0.17). Total EBL was 185 mL for the epinephrine side and 197 mL for control (p = 0.53). For Part II, there were 60 patients (mean age, 56 years), 28 women and 32 men. The MABP was 77 mmHg for the epinephrine group and 72 mmHg for control (p = 0.048). Preoperative MABP was 100 mmHg for the epinephrine group and 97 mmHg for control (p = 0.37). Duration of surgery was 2.25 hours for the epinephrine group and 2.08 hours for control (p = 0.17). Total EBL was 589 mL for the epinephrine group and 538 mL for control (p = 0.64).


CONCLUSIONS
There was no significant reduction in intraoperative blood loss during FESS when local anesthetic containing epinephrine was used compared with infiltration with NS. More importantly, Part II shows a significantly higher MABP associated with infiltration of epinephrine. Parts I and II did not show a significant difference in preoperative MABP or duration of surgery.
Javer
Amin R
AR
St. Paul's Sinus Center, Vancouver, British Columbia, Canada. sinussurgeon@shaw.ca
Gheriani
Heitham
H
Mechor
Brad
B
Flamer
David
D
Genoway
Krista
K
Yunker
Warren K
WK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002045:Bupivacaine / Q000008:administration & dosage*; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004724:Endoscopy / Q000379:methods*; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006489:Hemostatic Techniques; D006801:Humans; D007267:Injections; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D009666:Nose; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002045:Bupivacaine; D004837:Epinephrine