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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Comparison between topical anesthesia with cocaine versus lidocaine plus adrenal...
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Vol. 89. Issue 2.
Pages 53-57 (February 2014)
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Vol. 89. Issue 2.
Pages 53-57 (February 2014)
Original article
Comparison between topical anesthesia with cocaine versus lidocaine plus adrenaline for outpatient laser dacryocystorhinostomy
Comparación entre la anestesia tópica con cocaína y lidocaína con adrenalina en la dacriocistorrinostomía con láser
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F. Alañóna,
Corresponding author
fealfe1@hotmail.com

Corresponding author.
, M.A. Alañóna, J.A. Jiméneza, B. Caleroa, A. Noriegab, G. Plazab
a Instituto Lagrimal Internacional, Jaén, Spain
b Hospital Universitario de Fuenlabrada, Universidad Juan Carlos I, Madrid, Spain
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Tables (2)
Table 1. Differences between the 2 groups and pain assessed with analog-visual scale during TCLDCR under sedation and topical anesthesia.
Table 2. Differences between the 2 groups and complications.
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Abstract
Objective

To evaluate the effectiveness of topical anesthesia with cocaine versus lidocaine plus adrenaline for outpatient transcanalicular and endonasal dacryocystorhinostomy (TCLDCR) with diode laser under sedation.

Methods

A double blind randomized clinical trial was designed using topical anesthesia for outpatient TCLDCR in the treatment of adult epiphora. A total of 92 patients were enrolled, and randomly allocated to be operated on under sedation and topical anesthesia with cocaine 4% pledgets versus sedation and topical anesthesia with lidocaine 2% plus 1/100.000 adrenaline pledgets. Main outcome measures were postoperative comfort, evaluated by a visual analog scale, presence of secondary effects (blood pressure, heart rate), and resolution of epiphora, evaluated by Munk's scale and endoscopic control.

Results

Patients in both groups reported being comfortable during and immediately after TCLDCR. Visualization of the operative field was adequate, and surgery was successfully completed in all cases. Complications were more common in the cocaine group: sixteen patients from the cocaine group had high blood pressures, versus 2 patients from the lidocaine group (RR=8). Mean blood loss was 6.09ml in cocaine group, versus 2.05ml in lidocaine group (RR=6). Both parameters were statistically significant (p=1.1×10−9). There were no cases of postoperative epistaxis requiring nasal packing or hospital admission in any group. Success rate was similar in the 2 groups (86.96% group 1 and 89.13% group 2), after 6 months of follow-up.

Conclusions

The combination of topical lidocaine and adrenaline is more effective for outpatient transcanalicular and endonasal dacryocystorhinostomy than topical cocaine. Patient comfort was adequate in both groups, but high blood pressure and blood loss more common after cocaine.

Keywords:
Dacryocystorhinostomy
Transcanalicular
Endonasal-lacrimal
Laser
Diode
Cocaine
Lidocaine
Resumen
Objetivo

Comparar el uso de anestesia tópica de cocaína al 4% con la utilización de una mezcla de lidocaína al 2% y adrenalina al 1/100.000 para la dacriocistorrinostomía con láser (TCLDCR) y sedación consciente, sin infiltración local.

Métodos

En un estudio prospectivo, aleatorizado, a doble ciego, 46 pacientes fueron intervenidos tras la aplicación nasal de un apósito impregnado con cocaína al 4% y 46 pacientes fueron intervenidos tras emplear lidocaína al 2% y adrenalina 1/100.000 de idéntica forma. Se evaluó el bienestar intraoperatorio mediante la escala análogo visual, la presencia de alteraciones cardiovasculares (controlando la frecuencia cardiaca y la presión sanguínea) y la resolución de epífora con escala de Munk y control endoscópico.

Resultados

Los pacientes de ambos grupos estuvieron confortables durante la intervención, en el postoperatorio inmediato y a las 24 h tras la intervención. Los efectos secundarios cardiovasculares durante la cirugía fueron más frecuentes en el grupo de la cocaína. En el grupo 1, 16 pacientes tuvieron cifras tensionales elevadas frente a 2 del grupo 2, riesgo relativo (RR) 8. En el grupo 1, 12 enfermos presentaron frecuencia cardiaca por encima de 100 frente a uno del grupo 2, RR = 6. Un total de 12 pacientes del grupo 1 tuvieron un sangrado mayor de 5ml (media 6,1ml) frente a 2 del grupo 2 (media 2,1ml) RR = 6. Las diferencias entre el grupo 1 y el 2, en cuanto a estas 3 complicaciones, fueron significativas (p=1,1×10–9). En ningún grupo hubo casos de sangrado posquirúrgico que precisaran de taponamiento por más de 3 h. Los éxitos quirúrgicos fueron similares en ambos grupos 86,96 y 89,13% a los 6 meses de seguimiento.

Conclusiones

La combinación de lidocaína y adrenalina es efectiva para la DCR endoscópica con láser bajo anestesia tópica y sedación consciente. Esta combinación provee una adecuada anestesia y visualización del campo quirúrgico con menor sangrado e hipertensión arterial que la cocaína.

Palabras clave:
Dacriocistorrinostomía
Transcanalicular
Endonasal
Láser Diodo
Cocaína
Lidocaína

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