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

Overview

Drugs applied inside the nose to constrict blood vessels are standard in nasal surgery because they reduce bleeding and improve visibility. Cocaine and adrenaline are both used and both considered safe, though side effects have been described. This study compared the two on how well they worked and what they did to the heart and blood pressure.

Sections of note

• Prospective non-randomised study of 65 consecutive female patients having primary closed rhinoplasty.
• 33 patients received topical 4 percent cocaine solution and 32 received 1 in 1000 adrenaline solution.
• Vasoconstriction was assessed by measuring and grading bleeding during surgery.
• Systemic effects were assessed as cardiovascular changes during the procedure. Statistics used the Mann-Whitney test and mixed-effects models.
• Cocaine produced a stronger and more predictable narrowing of blood vessels, linked to better field quality but not to shorter operating times.
• Heart rate rose with both agents and was significantly higher with cocaine, p less than 0.05. Blood pressure did not differ significantly between groups. Level of evidence 5.

What it means for a patient

• Both drugs are applied inside the nose at the start of the operation and are standard practice, not experimental.
• Cocaine gave the surgeon a clearer view, but it did not shorten the operation.
• Cocaine raised heart rate more than adrenaline, which is the trade-off, though blood pressure was unaffected in this group.
• Patients were not randomly assigned, all were women, all had the closed approach, and the total was 65 at one centre, so the comparison is suggestive rather than definitive.

Why this paper matters

Topical cocaine has been used in nasal surgery for over a century and is increasingly restricted for regulatory reasons, making direct comparison with alternatives practically relevant. This study quantifies both sides of the trade. It cannot determine whether a clearer field changes the eventual result.

Terms

• Vasoconstrictor: a drug that narrows blood vessels to reduce bleeding.
• Topical: applied to the surface rather than injected or swallowed.
• Epinephrine: adrenaline, a hormone used as a drug to constrict blood vessels.
• Closed rhinoplasty: an approach performed entirely through incisions inside the nostrils.
• Systemic effect: an effect on the whole body rather than only where the drug was applied.
• Surgical field: the area the surgeon is working in during the operation.