Comparative study between lidocaine epinephrine, lidocaine ketamineepinephrine, and lidocaine dexamethasone epinephrine mixtures in rhinoplasty surgery

Abstract EN

Aim The aim of this study was to evaluate the prolongation of lidocaine epinephrine for local anesthesia (LA) of the nose for rhinoplasty by adding dexamethasone 8 mg or ketamine 100 mg.

Patients and methods Fifty-nine ASA I female patients aged 20–45 years scheduled for rhinoplasty surgery under LA were included in this randomized prospective study.

Patients were randomly assigned to have LA for the nose by injecting a volume of 32 ml of either lidocaine 1%+epinephrine (1 : 200 000) (group lidocaine, n = 20), lidocaine 1%+epinephrine (1 : 200 000) and 8 mg dexamethasone (group lidocaine dexamethasone, n = 20), or lidocaine 1%+epinephrine (1 : 200 000) and 100 mg ketamine (group lidocaine ketamine, n = 19).

Heart rate and NIBP were measured and recorded before injection of the LA and every 5 min after that until the end of surgery.

Any extra LA injection required by the patient was recorded.

The duration of sensory block was recorded.

Postoperative pain was measured by visual analog score and pain scores were obtained on arrival in the postanesthesia care unit ( PACU) and 1 and 2 h postoperatively.

Results The duration of sensory block was signifi cantly longer in the lidocaine ketamine group compared with the lidocaine group and the lidocaine dexamethasone group, and the duration was signifi cantly longer in the lidocaine dexamethasone group than the lidocaine group.

Only one (5.26%) patients in the lidocaine ketamine group required extra LA injection, whereas fi ve (25%) patients in the lidocaine dexamethasone group and eight (40%) in lidocaine group required extra LA injection; thus, the need for extra LA injection was signifi cantly lower in the lidocaine ketamine group.

Visual analog score in PACU and 1, and 2 h postoperatively showed signifi cant decrease in the lidocaine ketamine group in comparison with the lidocaine and lidocaine dexamethasone groups.

Heart rate, systolic blood pressure, and diastolic blood pressure showed no signifi cant difference among the three groups throughout the procedure.

Conclusion Addition of ketamine to lidocaine epinephrine mixture signifi cantly prolonged the duration of sensory block for rhinoplasty and signifi cantly decreased pain in PACU and 1 and 2 h postoperatively compared with lidocaine epinephrine mixture and lidocaine epinephrine dexamethasone mixture.

Thus, the addition of ketamine 100 mg to lidocaine epinephrine mixture is a useful adjuvant to lidocaine epinephrine admixture.