Cocaine and adrenaline: a safe or necessary combination in the nose? A study to determine the effect of adrenaline on the absorption and adverse side effects of cocaine.

The use of topical cocaine in nasal surgery is widely accepted. However, the value and safety of using adrenaline in addition is strongly disputed. Serial serum cocaine levels were estimated in 30 patients during routine nasal surgery with half the patients receiving preoperative nasal preparation with cocaine alone and the other half receiving a cocaine and adrenaline combination. The serum cocaine values and the incidence of toxic effects of cocaine were compared between the 2 groups. Results showed that the addition of adrenaline significantly reduced the systemic absorption of cocaine during surgery but caused no significant increase in toxic cardiovascular effects compared with the use of cocaine alone. No evidence of cocaine toxicity was seen in either group. Preparations including adrenaline were also observed to intensify local nasal vasoconstriction resulting in a better operative field. It is concluded that adrenaline can still be a valuable as well as safe addition to topical cocaine used in the nose.

RCT Entities:   Population Interventions Outcomes