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Both Lidocaine and Labetalol are equally effective in achieving controlled hypotension during middle ear surgery, the choice of their use depends on the surgeon’s choice and patient factors.
A recent study published in the Brazilian Journal of Otorhinolaryngology shed light on the efficacy of two commonly used medications, Labetalol (nonselective β-blocker) and Lidocaine infusion (local anaesthetic) in accomplishing deliberate hypotension during tympanoplasty. The findings suggest that both drugs effectively improve surgical conditions by regulating blood pressure levels. However, the choice between the two should be made based on patient characteristics and the discretion of the anesthesiologist.
Ali Karami et al. compared the influence of this nonselective β-blocker and local anaesthetic on hemodynamic changes and peri-operative outcomes in 64 patients lined for tympanoplasty. These patients were randomized into 2 groups, namely- the Labetalol group (Labetalol dosed at 0.5mg-2 mg/min) and the Lidocaine group (Lidocaine infusion 1% dosed at 1.5 mg/kg/h) for deliberate hypotension during surgery. Drug effectiveness was evaluated by comparing the Mean Arterial Pressure (MAP), surgeon's satisfaction, time to attain the target MAP, bleeding volume, pain scores after surgery, post-surgical anaesthetic use, sedation and additional parameters.
In the Labetalol group, the median bleeding volume stood at 10 cc, slightly lower than the Lidocaine group's 30 cc, but was not statistically noteworthy. Similarly, no statistically significant discrepancies were observed between the two groups regarding the surgeon's satisfaction level, pain and sedation levels during the recovery phase. Furthermore, the surgical duration, recovery period, and time to extubation between the groups had insignificant differences. Both medications needed roughly 20 minutes to reach the target MAP and displayed similar hemodynamic responses (p > 0.05).
Brazilian Journal of Otorhinolaryngology
Comparison of Labetalol and Lidocaine in induction of controlled hypotension in tympanoplasty: a randomized clinical trial
Ali Karami et al.
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