Comparison of Oral Preoperative Clonidine with Infusion of Intraoperative Labetalol on Bleeding during Tympanoplasty Surgery.

Abstract

Introduction: Surgical bleeding is one of the most critical complications in various surgical procedures. In middle ear surgery, managing bleeding is a significant challenge for anesthesiologists because even minor bleeding can obstruct the surgeon's vision and prolong the surgery. Our objective is to compare the impact of preoperative oral clonidine versus labetalol infusion on bleeding volume during tympanoplasty surgery.

Materials and methods: In this double-blind randomized controlled trial, tympanoplasty candidates were randomly assigned to three groups: the clonidine group (received 300 micrograms of clonidine tablets one hour before surgery with normal saline infusion during the operation), the control group (given a placebo tablet one hour before surgery with normal saline infusion during surgery), and the labetalol group (administered a placebo tablet one hour before surgery with labetalol infusion at a rate of 0.2 mg/kg of body weight per hour during surgery). We then evaluated the extent of intraoperative bleeding, systolic and diastolic blood pressure, mean arterial pressure, and heart rate at various time points until the end of the surgery.

Results: Clonidine and labetalol were effective in reducing intraoperative bleeding compared to the control group. Grade 2 bleeding (minimal bleeding requiring intermittent suction) was the highest grade observed across all three groups and was consistently noted in all patients. Clonidine demonstrated greater efficiency in reducing systolic and diastolic blood pressure, mean arterial pressure, and heart rate compared to both labetalol and the control group.

Conclusion: Premedication with clonidine or labetalol is associated with reduced intraoperative bleeding, improved surgical field visibility, and shorter duration of tympanoplasty procedures. This may potentially lead to increased satisfaction and success rates of the operation.