Comparison of oxymetazoline and lidocaine versus cocaine for outpatient dacryocystorhinostomy

Purpose: To evaluate the effectiveness of oxymetazoline combined with lidoc aine versus cocaine for outpatient dacryocystorhinostomy (DCR). Methods:Twenty-seven patients underwent DCR with a combination of oxymetazo line 0.05% nasal spray and lidocaine 4% spray/pledgetts (oxy/lido) and were compared with 28 patients who underwent DCR with cocaine 4% pledgetts for nasal anesthesia and vasoconstriction. Most of the patients underwent stand ard external approach DCR: five patients in the oxy/lido group and four pat ients in the cocaine group underwent endoscopic DCR. Results: Patients in both groups reported being comfortable during and imme diately after surgery. Visualization of the operative field was adequate, a nd surgery was successfully completed in all cases. Mean blood loss was 6.3 mi (+/-6.0) in the oxy/lido group and 7.3 mi (+/-6.4) in the cocaine group (p = 0.541). There were no cases of postoperative epistaxis requiring nasa l packing or hospital admission in the oxy/lido group, whereas one patient in the cocaine group developed epistaxis 8 days after surgery, which requir ed treatment. Success rate was similar in the two groups. Conclusions: The combination of oxymetazoline and lidocaine is effective fo r outpatient dacryocystorhinostomy. Patient comfort was adequate and blood loss not significantly different in comparison to cocaine. This combination provides effective nasal anesthesia and vasoconstriction, while avoiding t he "hassle" and potentially greater risks associated with cocaine.