A randomized double-blind trial comparing lidocaine and dexmedetomidine infusions for intraoperative bleeding in patients undergoing functional endoscopic sinus surgery

Abstract

Objectives: To evaluate the efficacy of lidocaine and dexmedetomidine infusions in controlling intraoperative bleeding during FESS. Methods: Sixty subjects undergoing FESS were involved in a randomized, double-blind investigation and allocated into two distinct treatment arms. Group L was treated with an initial lidocaine bolus of 1.5 mg/kg, subsequently maintained with a continuous infusion at a rate of 1 mg/kg/h. Conversely, Group D received a 1 µg/kg loading dose of dexmedetomidine, followed by a maintenance infusion adjusted to a rate between 0.4 and 0.7 µg/kg/h. Results: Subjects in Group D demonstrated a notably improved surgical field quality, as indicated by a median Fromme score of 1 (range 0-2), in contrast to a median score of 2 (range 1-2) in Group L (P = 0.004). Furthermore, beginning 10 minutes post-induction and persisting until the end of surgery, Group D displayed notably minor heart rate and mean arterial pressure values. A significant prolongation in the time to first rescue analgesic requirement was observed in Group D compared to Group L (P < 0.001), accompanied by reduced total morphine consumption (P = 0.004). Postoperative pain, assessed using the visual analog scale, was notably lower in Group D at the 2-, 4-, and 6-hour time points. Surgeon satisfaction was notably superior for the surgical conditions provided by Group D (P = 0.028). Conclusions: Dexmedetomidine infusion provides superior surgical field quality and postoperative analgesia compared to lidocaine during FESS, with a comparable safety profile. Keywords: Dexmedetomidine, Functional Endoscopic Sinus Surgery, Intraoperative Bleeding, Lidocaine, Surgical Field Quality Citation: Eldemerdash AM, Afifi SA, Afifi S. A Randomized Double-Blind Trial Comparing Lidocaine and Dexmedetomidine Infusions for Intraoperative Bleeding in Patients Undergoing Functional Endoscopic Sinus Surgery. Anaesth. pain intensive care 2026;30(6):732-741. DOI: 10.35975/apic.v30i6.3267 Received: xx; Revised: xx; Accepted: xx