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Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions

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Abstract

Background

The use of topical vasoconstrictors is a common practice in nasal surgery. These agents reduce bleeding and enable a good surgical field. Topical cocaine and epinephrine, which are frequently used in cosmetic rhinoplasty, are considered safe and effective, but secondary effects have been described. The aim of the present study was to evaluate and compare the benefits and risks of epinephrine and cocaine employed as topical vasoconstrictive agents in cosmetic rhinoplasty.

Methods

This prospective non-randomised study included 65 consecutive female patients undergoing primary closed rhinoplasty. Patients were treated with topical aqueous solutions of 4 % cocaine (n = 33) or 1:1000 epinephrine (n = 32). Benefits and risks of drug use were compared between groups. Vasoconstriction was assessed by quantitative and qualitative evaluation of bleeding during surgery. Systemic effects were studied in terms of cardiovascular changes during the procedure. The Mann–Whitney test and mixed-effects models were used to compare continuous variables and to assess the effects of vasoconstrictor treatment, respectively.

Results

Cocaine exerted a stronger and more predictable vasoconstrictive effect than epinephrine. This difference was linked to better field quality, but did not relate to shorter surgery times. Increased heart rate was detected with both agents and was significantly higher with cocaine (p < 0.05). Blood pressure did not significantly differ between groups.

Conclusions

Both cocaine and epinephrine, at the concentrations used in this study, are suitable as topical vasoconstrictive agents in aesthetic rhinoplasty.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Authors and Affiliations

  1. Clínica Fernández Aesthetic Surgery, Oviedo, Spain

    Sergio Fernández-Cossío & José Manuel Fernández-Álvarez

  2. Department of Anesthesiology, Asturias Central University Hospital, Oviedo, Spain

    María Jesús Rodríguez-Dintén

  3. Clinical Epidemiology Unit, University Hospital Complex of Santiago de Compostela, Santiago De Compostela, Spain

    Francisco Gude

Authors
  1. Sergio Fernández-Cossío
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  2. María Jesús Rodríguez-Dintén
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  3. Francisco Gude
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  4. José Manuel Fernández-Álvarez
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Correspondence to Sergio Fernández-Cossío.

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There are no commercial associations that might pose or create a conflict of interest with information presented in this manuscript. There was no external funding for this study. As stated in the consent form submitted, no authors have financial interest in the subject matter of this manuscript.

Research Involved in Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Fernández-Cossío, S., Rodríguez-Dintén, M.J., Gude, F. et al. Topical Vasoconstrictors in Cosmetic Rhinoplasty: Comparative Evaluation of Cocaine Versus Epinephrine Solutions. Aesth Plast Surg 40, 637–644 (2016). https://doi.org/10.1007/s00266-016-0673-2

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  • DOI: https://doi.org/10.1007/s00266-016-0673-2

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