Indian Journal of Anaesthesia  
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Year : 2013  |  Volume : 57  |  Issue : 2  |  Page : 163-169

Phenylephrine as an alternative to cocaine for nasal vasoconstriction before nasal surgery: A randomised trial

1 Beachwood Ambulatory Surgicenter, Anesthesiology Institute, Cleveland, OH, USA
2 Anesthesiology Institute, Cleveland, OH, USA
3 Department of Quantitative Health Sciences, Learner Research Institute; Department of Outcomes Research, Anesthesiology Institute, Cleveland, OH, USA
4 Department of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA

Correspondence Address:
Basem B Abdelmalak
Department of General Anesthesiology, Cleveland Clinic, E-31, 9500 Euclid Avenue, Cleveland, OH
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Source of Support: All financial and administrative support was provided by the Anesthesiology Institute and the Department of Outcomes Research at the Cleveland Clinic Foundation,, Conflict of Interest: None

DOI: 10.4103/0019-5049.111844

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Background: Cocaine is often used topically to provide the profound vasoconstriction required for nasal surgery; however, it has been associated with intraoperative cardiac adverse effects. We compared cocaine with phenylephrine as an alternative to ascertain their relative efficacy as vasoconstrictors in nasal septoplasty. Methods: Adult patients, presenting for elective nasal septoplasty, of American Society of Anaesthesiologists physical status I-III, were randomised to either 0.5% phenylephrine or 4% cocaine. The primary outcome was quality of vasoconstriction on a 5-point scale (1=unacceptable, 5=excellent), rated by the surgeon at the end of the procedure. Results: Twenty-nine patients received phenylephrine and 26 received cocaine. The median rating for quality of the vasoconstriction was 4.0 (good) in both the phenylephrine and cocaine groups ( P=0.84). Median blood loss was 50 ml in the phenylephrine group and 62.5 ml in the cocaine group ( P=0.49). In secondary analyses, phenylephrine was shown to be non-inferior to cocaine on both quality of vasoconstriction (non-inferiority delta of 1 point, P=0.009) and estimated blood loss (non-inferiority delta of 25 ml, P=0.028). The frequency of ventricular ectopy, ST segment changes or blood pressure changes after nasal packing was not significantly different between the two groups. Conclusion: Phenylephrine in a concentration of 0.5% is not different from 4% cocaine on the quality of vasoconstriction in septoplasty. Given the abuse potential of cocaine and the added administrative burden associated with its handling, phenylephrine might serve as an alternative.

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