APS Aesthetic Plastic Surgery · 2011

Can elimination of epinephrine in rhinoplasty reduce the side effects: introduction of a new technique

Kalantar-Hormozi A, Fadaee-Naeeni A, Solaimanpour S, Mozaffari N, Yazdanshenas H, Bazargan-Hejazi S.

PubMed 21359979 Publisher (DOI)Free full text (PMC)

What this paper says

In a randomized study of 113 rhinoplasty patients, leaving out the epinephrine injection did not change bleeding or operating time, and the group without it had fewer complications (P = 0.01).

Overview

Surgeons inject epinephrine into the nose before rhinoplasty to shrink blood vessels and reduce bleeding. Epinephrine can also raise heart rate and blood pressure. The authors tested whether the injection can be dropped when anesthesia is run as a continuous intravenous infusion, comparing bleeding, surgery time and complications.

Sections of note

113 patients randomized: control with epinephrine 1:100,000 injection (n = 74) and intervention without it (n = 39).
Primary open or closed rhinoplasty under continuous remifentanil (14 to 20 micrograms per hour) and propofol (4 to 6 mg/kg/h) infusion plus 50% nitrous oxide; atracurium 5 mg every 20 minutes.
All patients received dexamethasone 8 mg and metoclopramide 10 mg intravenously.
No significant link between epinephrine and bleeding during or after surgery (P = 0.949).
Fewer complications in the no-epinephrine group (P = 0.01); the abstract does not list the complication types or counts.
No significant difference in operating time.

What it means for a patient

With this anesthetic regimen, skipping the epinephrine injection did not make the operation bloodier or longer.
The complication finding favored the no-epinephrine group, but the abstract does not say what those complications were.
The groups were unequal in size and the authors call for larger studies; results depend on the specific anesthetic protocol used.

Why this paper matters

Epinephrine injection is near-universal in rhinoplasty. This trial questions whether it is needed when anesthesia already keeps blood pressure low. Whether the finding holds under other anesthetic techniques, or in revision cases, is not addressed.

Terms

Epinephrine: adrenaline; injected to constrict blood vessels and limit bleeding.
Randomized: patients assigned to groups by chance to avoid bias.
Remifentanil: a short-acting opioid given by infusion during anesthesia.
Propofol: an intravenous anesthetic drug.
Atracurium: a muscle relaxant used during general anesthesia.
Extubation: removal of the breathing tube at the end of anesthesia.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: We aim to provide evidence that despite not administering epinephrine, (1) the amount of hemorrhaging during surgery will not change, (2) surgery time will not increase and may even be shorter, and (3) there would be fewer cardiovascular-related consequences.

Methods: One hundred thirteen patients were enrolled and randomized into the control (n = 74) and intervention groups (n = 39). During the primary open or closed rhinoplasty operation, anesthesia was managed by continual infusion of remifentanil (14-20 μg/h) and propofol (4-6 mg/kg/h) with an infusion pump, in addition to N(2)O-O(2) (50%). Atracurium was repeated (5 mg every 20 min). Patients in the control group received an epinephrine (1/100,000) injection to the nose, and patients in the intervention group did not. All patients received dexamethasone (8 mg IV) and metoclopramide (10 mg IV). At the end of the operation and before extubation, the muscle relaxants were reversed with prostigmine (0.35 mg/kg) and atropine (0.175 mg/kg).

Results: We found (1) no statistically significant association between epinephrine injection and hemorrhage during or after surgery (P = 0.949), (2) a statistically significant association between epinephrine injection and complications, and (3) the group that did not receive the injection had fewer complications (P = 0.01). With respect to the duration of surgery, we did not detect any statistically significant associations between the groups.

Conclusion: Elimination of epinephrine during rhinoplasty as an alternative procedure may lead to the same surgery outcomes if not a better one. Studies with a larger sample size are needed to further substantiate these findings.

Abstract as indexed by PubMed; the article is open access (PubMed Central).