The effect of lidocaine, bupivacaine and ropivacaine in nasal packs on pain and hemorrhage after septoplasty

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Karaman E., Gungor G., Alimoglu Y., Kilic E., Tarakci E., Bozkurt P., ...Daha Fazla

EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, cilt.268, ss.685-689, 2011 (SCI-Expanded, Scopus) identifier identifier identifier

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We aimed to investigate the effects of local anesthetics soaked in Merocel nasal packs on hemorrhage and pain after septoplasty. The methodology includes a prospective double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation. The study included 143 patients. The patients were divided into four groups. Each group received 1% lidocaine + 0.000625% adrenalin, 0.375% ropivacaine, 0.25% bupivacaine as study groups or 0.9% sodium chloride as a control group in their Merocel packs postoperatively. The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. The statistical analysis was performed using two sided t test on each patient group at each time point. The results included the patients in the control group needing rescue drug most often. There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug. The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups. Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour.The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th, 8th and the 24th hours. The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th, 16th and the 20th hours. The ropivacaine group had significantly better pain scores versus control group in the 8th, 12th, 16th, 20th and 24th postoperative hours. The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour. The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours. There was no statistically significant difference between the study groups in terms of postoperative hemorrhage. We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding. Topical bupivacaine application to nasal packs should be considered after septoplasty.

Abstract We aimed to investigate the effects of local
anesthetics soaked in Merocel nasal packs on hemorrhage
and pain after septoplasty. The methodology includes a
prospective double-blind study that was conducted in
patients undergoing septoplasty because of nasal septal
deviation. The study included 143 patients. The patients
were divided into four groups. Each group received 1%
lidocaine ? 0.000625% adrenalin, 0.375% ropivacaine,
0.25% bupivacaine as study groups or 0.9% sodium chloride
as a control group in their Merocel packs postoperatively.
The local anesthetics or sodium chloride were
reapplied at the eighth postoperative hour. Each patient
was given a questionnaire where verbal analog score and
amount of postoperative hemorrhage was noted. The statistical
analysis was performed using two sided t test on
each patient group at each time point. The results included
the patients in the control group needing rescue drug most
often. There was no statistically significant difference
between bupivacaine and lidocaine plus adrenalin in the
patients who requested rescue drug. The patients in the
ropivacaine group requested rescue drug more frequently
than the bupivacaine and lidocaine plus adrenalin groups.
Bupivacaine group had significantly better pain scores
versus control group at all intervals except for the first
postoperative hour.The bupivacaine group had better pain
scores versus ropivacaine and lidocaine plus adrenalin
groups in the 4th, 8th and the 24th hours. The bupivacaine
group had better pain scores versus lidocaine plus adrenalin
in the 12th, 16th and the 20th hours. The ropivacaine group
had significantly better pain scores versus control group in
the 8th, 12th, 16th, 20th and 24th postoperative hours. The
ropivacaine group scored better than lidocaine plus
adrenalin group just in the 16th hour. The lidocaine plus
adrenalin group had significantly better pain scores versus
control group in 4th and 12th hours. There was no statistically
significant difference between the study groups in
terms of postoperative hemorrhage. We concluded that
bupivacaine use in nasal surgery provides better analgesia
at least in the first 8 h period and does not cause more
bleeding. Topical bupivacaine application to nasal packs
should be considered after septoplasty.
Keywords Local anesthetics  Analgesia  Nasal septum 
Postoperative pain