The effects of formulation and addition of adrenaline to cocaine for haemostasis in intranasal surgery.

Twenty patients presenting for submucous resection of the nasal septum under general anaesthesia were randomly allocated to four groups to receive either 1.0 ml 25% cocaine HCl in paraffin paste, 1.0 ml 25% cocaine HCl combined with 0.1% adrenaline in paraffin paste, 4.0 ml aqueous 4% cocaine HCl combined with 0.05% adrenaline or 4.0 ml aqueous 4% cocaine HCl on ribbon gauze applied to the nasal mucosa. Mean intraoperative blood loss was significantly decreased when the 25% cocaine 0.1% adrenaline combination in paraffin paste was used (11 (SD 8) ml, 60 (SD 30) ml, P less than 0.05, for adrenaline and plain paste respectively). Combination of adrenaline with cocaine in the aqueous formulation was not associated with a significant decrease in blood loss compared with aqueous cocaine alone (75 (SD 51), 96 (SD 66) ml respectively). Cocaine adrenaline paste and plain cocaine paste were associated with higher mean maximum cocaine blood concentrations (1.6 (SD 1.4), 2.0 (SD 1.5) micrograms/ml respectively) when compared with aqueous cocaine adrenaline and aqueous cocaine alone (0.03 (SD 0.003), 0.5 (SD 0.3) microgram/ml respectively). Heart rate and blood pressure changes were similar in all four groups and cardiovascular toxicity was not observed. One ml of topical intranasal 25% cocaine HCl with 0.1% adrenaline in paraffin paste provided the best haemostasis for nasal septal surgery.