Local Shots with Epinephrine Under General Anethesia. Do You Really Need the Epinephrine for Eye and Nose Work?

Great question.  It is first very important to understand that the eyelids and especially the nose are incredibly vascular structures.  It is fairly standard to use some form of local anesthesia (lidocaine) in conjunction with a dilute for of epinephrine in order to minimize pain (which minimizes need for intravenous sedation and pain control agents) and bleeding.  Epinephrine constricts blood vessels and thereby helps minimize blood loss, improve operative visualization, and minimize local swelling.  All of these factors help ensure greater consistency in results and less downtime.

Yes, the epinephrine in the solution constricts the blood vessels in the areas that are being treated.  If the epinephrine was not in the solution, your surgery would likely be a bloody mess and you would have significant post op bruising.  Areas of the face, especially the eyes and the nose, have very strong blood supply.  So epinephrine is essential.  

 

Good Luck.

The epinephrine in the local shots is very important because the epinephrine causes a restriction of blood vessels in the local area so that the procedure can be performed without extensive bleeding.  Injections in the head and neck without epinephrine will result in numbness with excess bleeding.  The epinephrine is used for both numbness and excess bleeding.  The epinephrine also extends the length of the numbing medication as well.

Local anesthetic injections are given even under general anesthesia for a few reasons. The epinephrine makes a huge difference in the amount of bleeding, making the surgery more precise and easier to perform. Also, when you add a long acting anesthetic, such as bupivicaine, to the mix the patient will be comfortable for several hours after the procedure.  

This is an absolutely critical step in any plastic surgery performed under general anesthesia. Without the effects of the epinephrine in particular, the bruising that would be seen after surgery would be many times worse and takes weeks longer to go away.

I use epinephrine in the local during eyelid or nasal surgery to minimize bleeding during the procedure so that the surgery can be performed precisely.

Having epinephrine in the local anesthetic for procedures on the eye and nose is absolutely critical in my hands.  The epinephrine contracts the blood vessels and there is less bleeding with the procedure.  With less bleeding the delicate anatomy in these areas is much more clear and the procedure is safer to perform.  

If your lid procedure or rhinoplasty was under general anesthesia we suppose that the epinephrine alone would do. However, we use the epi to constrict the blood vessels in these areas so that we can see clearly and do good work, and reduce any bruise after surgery.

Yes. You do need local anesthetic with adrenaline for eye and nasal surgery even under general anesthesia. The reasons are that local anesthetic with adrenaline:


Minimizes bleeding

Reduces the risk of bleeding related complications after surgery

Numbs the tissue which reduces the amount of general anesthetic drugs that you will require.
I hope this information is helpful.Stephen Weber MD, FACS

use of local anesthetic with epinephrine especially in eyes and nose surgery is standard practice and leads to decreased operative bleeding and post-operative bruising and hematoma formation and improved visibility for the surgeon by keeping the operative  field dry