A A randomized double-blind trial comparing lidocaine and dexmedetomidine infusions for intraoperative bleeding in patients undergoing FESS

Abstract

Background & Objectives: Functional endoscopic sinus surgery (FESS) is frequently associated with intraoperative profuse bleeding. The bleeding, if excessive, might result into poor vision and thus difficulty to the operating surgeon. The anesthetists employ various drugs to control the bleeding.

We evaluated 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.

Abbreviations: FESS: Functional endoscopic sinus surgery, PACU: post-anesthesia care unit

Keywords: Dexmedetomidine, Functional Endoscopic Sinus Surgery, Intraoperative Bleeding, Lidocaine, Surgical Field Quality

Citation: Eldermerdash AM, Afifi S, Ahmed DS. A randomized double-blind trial comparing lidocaine and dexmedetomidine infusions for intraoperative bleeding in patients undergoing FESS. Anaesth. pain intensive care 2026;30(5):552-560. DOI: 10.35975/apic.v30i5.3239

Received: December 03, 2025; Revised: January 13, 2026; Accepted: April 24, 2026