Comparison of the Effects of Levobupivacaine with Lidocaine- Epinephrine on Decongestion and Bleeding during Functional Endoscopic Sinus Surgery

Abstract

Background and Objectives : Bleeding and congestion during functional endoscopic sinus surgery (FESS) can affect directly to the visibility of safe landmarks and surgical outcomes. Levobupivacaine is a long-acting local anesthetic with inherent local vasoconstrictor activity that is effective when administered by local infiltration to the skin. We aimed to compare the use of pre-incision levobupivacaine and lidocaine 2% with epinephrine for intraoperative vasoconstriction and postoperative analgesia in patients undergoing functional endoscopic sinus surgery. Methods : After institutional approval and informed patient consent, fifty six patients were randomly assigned to receive preincisional local infiltration under general anesthesia. Group LB received levobupivacaine 0.25% (n=28) and group LD-E (n=28) received epinephrine plus lidocaine 2%. Decongestion level of the middle turbinate, the occurrence of hemodynamic variability, intraoperative bleeding scores, the quality of the surgical field, and the first rescue analgesic time in 24 h of all patients were recorded. At the 10 th minute, nasal mucosa images were more decongested compared to the images at 5 th minute in levobupivacaine and lidocaine plus epinephrine groups (p=0.00 and p=0.01 respectively). Results : Decongestion level of the middle turbinate, intraoperative bleeding scores, the quality of the surgical field and first rescue analgesic time were similar between the groups (p>0.05). Conclusions : Levobupivacaine may be an alternative to lidocaine plus epinephrine because it provides similar surgical visibility and postoperative analgesia in patients undergoing FESS.