Cocaine, Tetracaine / Oxymetazoline and Ropivacaine / Oxymetazoline in Functional Endoscopic Sinus Surgery

Objective : Endonasal cocaine gauzes are applied during functional endoscopic sinus surgery (FESS) for their combined analgesic and decongestive properties. Seeking an alternative for cocaine, tetracaine/oxymetazoline, and ropivacaine/oxymetazoline were investigated for their efficacy and safety during FESS. Methods : Over 18 months a double-blinded randomised prospective intervention study was conducted. Ninety patients were allocated to 3 groups that received a blinded 5 ml solution containing cocaine 5 %, tetracaine 0.8 % plus oxymetazoline 0.02 % or ropivacaine 0.8% plus oxymetazoline 0.02 %. Two Ear Nose Throat surgeons participated and evaluated preprocedural decongestion, postoperative decongestion and haemostasis according to a numeric rating scale (NRS, 0 - 10). Postoperative pain scores (NRS) registered until discharge. Secondary outcomes were intraoperative blood loss, perioperative hemodynamics, postoperative bandage changes, morphine consumption, nausea and vomiting. Results : No significant difference was observed between groups for preprocedural decongestion (p = 0.72) and postoperative decongestion (p = 0.48) and haemostasis (p = 0.44). Mean postoperative pain scores were low (NRS 1.00, SD 1.15) without significant difference (p = 0.55). Conclusion : Based on the results of this study we can recommend tetracaine / oxymetazoline or ropivacaine / oxymetazoline as a safe and effective topical agent for FESS that can replace cocaine.