Fernández-Cossío Sergio, Rodríguez-Dintén María Jesús, Gude Francisco, Fernández-Álvarez José Manuel
Clínica Fernández Aesthetic Surgery, Oviedo, Spain.
Department of Anesthesiology, Asturias Central University Hospital, Oviedo, Spain.
Aesthetic Plast Surg. 2016 Oct;40(5):637-44. doi: 10.1007/s00266-016-0673-2. Epub 2016 Jun 29.
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.
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.
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.
Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty.
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局部血管收缩剂在鼻科手术中是常用的。这些药物可减少出血并提供良好的手术视野。常用于隆鼻整形手术的局部可卡因和肾上腺素被认为是安全有效的，但也有副作用的报道。本研究的目的是评估和比较肾上腺素和可卡因作为局部血管收缩剂在隆鼻整形手术中的益处和风险。
这项前瞻性非随机研究纳入了65例连续接受初次闭合性隆鼻手术的女性患者。患者分别接受4%可卡因（n = 33）或1:1000肾上腺素（n = 32）的局部水溶液治疗。比较两组药物使用的益处和风险。通过手术中出血的定量和定性评估来评估血管收缩情况。从手术过程中的心血管变化方面研究全身影响。分别使用曼-惠特尼检验和混合效应模型来比较连续变量并评估血管收缩剂治疗的效果。
可卡因比肾上腺素具有更强且更可预测的血管收缩作用。这种差异与更好的视野质量有关，但与手术时间缩短无关。两种药物均检测到心率增加，且可卡因组显著更高（p < 0.05）。两组间血压无显著差异。
在本研究中使用的浓度下，可卡因和肾上腺素均适合作为隆鼻整形手术中的局部血管收缩剂。
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