ORIGINAL ARTICLE
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 314-319

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


Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
Sahar M Talaat
Department Of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.139556

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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 significantly longer in the lidocaine ketamine group compared with the lidocaine group and the lidocaine dexamethasone group, and the duration was significantly 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 five (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 significantly lower in the lidocaine ketamine group. Visual analog score in PACU and 1, and 2 h postoperatively showed significant 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 significant difference among the three groups throughout the procedure. Conclusion Addition of ketamine to lidocaine epinephrine mixture significantly prolonged the duration of sensory block for rhinoplasty and significantly 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.


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