Can Elimination of Epinephrine in Rhinoplasty Reduce the Side Effects: Introduction of a New Technique

BACKGROUND: We aim to provide evidence that despite not administering epinephrine, (1) the amount of hemorrhaging during surgery will not change, (2) surgery time will not increase and may even be shorter, and (3) there would be fewer cardiovascular-related consequences. METHODS: One hundred thirteen patients were enrolled and randomized into the control (n = 74) and intervention groups (n = 39). During the primary open or closed rhinoplasty operation, anesthesia was managed by continual infusion of remifentanil (14–20 μg/h) and propofol (4–6 mg/kg/h) with an infusion pump, in addition to N(2)O–O(2) (50%). Atracurium was repeated (5 mg every 20 min). Patients in the control group received an epinephrine (1/100,000) injection to the nose, and patients in the intervention group did not. All patients received dexamethasone (8 mg IV) and metoclopramide (10 mg IV). At the end of the operation and before extubation, the muscle relaxants were reversed with prostigmine (0.35 mg/kg) and atropine (0.175 mg/kg). RESULTS: We found (1) no statistically significant association between epinephrine injection and hemorrhage during or after surgery (P = 0.949), (2) a statistically significant association between epinephrine injection and complications, and (3) the group that did not receive the injection had fewer complications (P = 0.01). With respect to the duration of surgery, we did not detect any statistically significant associations between the groups. CONCLUSION: Elimination of epinephrine during rhinoplasty as an alternative procedure may lead to the same surgery outcomes if not a better one. Studies with a larger sample size are needed to further substantiate these findings.