Kubo N, Nakamura A, Yamashita T
Department of Otolaryngology, Kansai Medical University, Osaka.
Nihon Jibiinkoka Gakkai Kaiho. 1995 Aug;98(8):1263-9. doi: 10.3950/jibiinkoka.98.1263.
A 4% cocaine (total dose; 200 mg) solution with 1 mg epinephrine was used as a topical anesthetic for 178 cases undergoing functional endoscopic sinus surgery. Complications were investigated before and during surgery. Bleeding amount and operative duration were compared between patients with and without topical cocaine application. Tachycardia (26 cases) was the only complication encountered in this study. Tachycardia occurred at a high incidence in cases which used atropine as a premedication. Total bleeding amount did no differ significantly between those with and without topical cocaine. However, minimum bleeding cases (less than 20 ml) were found in the cocaine group more frequently than in the non-cocaine group. Operative durations of cases with cocaine anesthesia were significantly shorter than cases without cocaine anesthesia. Those findings suggest that cocaine is effective for prevention of bleeding from micro-vessels and/or mucosal oozing, whereas bleeding from macro-vessels was not controlled by topical cocaine application. Topical cocaine anesthesia produced no major complications, even at 200 mg, in the presence of 1 mg epinephrine and when atropine use was avoided.
将含1 mg肾上腺素的4%可卡因溶液（总量200 mg）用作178例行功能性内镜鼻窦手术患者的局部麻醉剂。在手术前和手术过程中对并发症进行调查。比较使用和未使用局部可卡因的患者之间的出血量和手术持续时间。心动过速（26例）是本研究中唯一遇到的并发症。在使用阿托品作为术前用药的病例中，心动过速发生率很高。使用和未使用局部可卡因的患者之间的总出血量无显著差异。然而，可卡因组中最小出血量病例（少于20 ml）的出现频率高于非可卡因组。可卡因麻醉病例的手术持续时间明显短于未使用可卡因麻醉的病例。这些发现表明，可卡因对预防微血管出血和/或黏膜渗血有效，而局部应用可卡因不能控制大血管出血。在存在1 mg肾上腺素且避免使用阿托品的情况下，即使使用200 mg局部可卡因麻醉也不会产生重大并发症。
