title: Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions.
abstract: BACKGROUND
  The use of topical vasoconstrictors is a common practice in nasal surgery. These agents reduce bleeding and enable a good surgical field. Topical cocaine and epinephrine, which are frequently used in cosmetic rhinoplasty, are considered safe and effective, but secondary effects have been described. The aim of the present study was to evaluate and compare the benefits and risks of epinephrine and cocaine employed as topical vasoconstrictive agents in cosmetic rhinoplasty.
  
  
  METHODS
  This prospective non-randomised study included 65 consecutive female patients undergoing primary closed rhinoplasty. Patients were treated with topical aqueous solutions of 4 % cocaine (n = 33) or 1:1000 epinephrine (n = 32). Benefits and risks of drug use were compared between groups. Vasoconstriction was assessed by quantitative and qualitative evaluation of bleeding during surgery. Systemic effects were studied in terms of cardiovascular changes during the procedure. The Mann-Whitney test and mixed-effects models were used to compare continuous variables and to assess the effects of vasoconstrictor treatment, respectively.
  
  
  RESULTS
  Cocaine exerted a stronger and more predictable vasoconstrictive effect than epinephrine. This difference was linked to better field quality, but did not relate to shorter surgery times. Increased heart rate was detected with both agents and was significantly higher with cocaine (p < 0.05). Blood pressure did not significantly differ between groups.
  
  
  CONCLUSIONS
  Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Clínica Fernández Aesthetic Surgery, Oviedo, Spain. sergio@clinicafernandez.com.
authors.forename: Sergio
authors.identifier: http://orcid.org/0000-0002-7158-7000
authors.initials: S
authors.lastname: Fernández-Cossío
authors.affiliation: Department of Anesthesiology, Asturias Central University Hospital, Oviedo, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Rodríguez-Dintén
authors.affiliation: Clinical Epidemiology Unit, University Hospital Complex of Santiago de Compostela, Santiago De Compostela, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude
authors.affiliation: Clínica Fernández Aesthetic Surgery, Oviedo, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Fernández-Álvarez
mesh_terms: D000287:Administration, Topical; D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003042:Cocaine / Q000008:administration & dosage*; D015331:Cohort Studies; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061214:Patient Safety; D011446:Prospective Studies; D012225:Rhinoplasty / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D003042:Cocaine; D004837:Epinephrine
keywords: Cocaine; Epinephrine; Rhinoplasty; Topical; Vasoconstrictors