{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:48:25Z","timestamp":1787071705030,"version":"build-2736575974"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,3]]},"abstract":"\n Background:<\/jats:title>\n Cocaine is often used topically to provide the profound vasoconstriction required for nasal surgery; however, it has been associated with intraoperative cardiac adverse effects. We compared cocaine with phenylephrine as an alternative to ascertain their relative efficacy as vasoconstrictors in nasal septoplasty.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n Adult patients, presenting for elective nasal septoplasty, of American Society of Anaesthesiologists physical status I-III, were randomised to either 0.5% phenylephrine or 4% cocaine. The primary outcome was quality of vasoconstriction on a 5-point scale (1=unacceptable, 5=excellent), rated by the surgeon at the end of the procedure.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Twenty-nine patients received phenylephrine and 26 received cocaine. The median rating for quality of the vasoconstriction was 4.0 (good) in both the phenylephrine and cocaine groups (\n P<\/jats:italic>\n =0.84). Median blood loss was 50 ml in the phenylephrine group and 62.5 ml in the cocaine group (\n P<\/jats:italic>\n =0.49). In secondary analyses, phenylephrine was shown to be non-inferior to cocaine on both quality of vasoconstriction (non-inferiority delta of 1 point,\n P<\/jats:italic>\n =0.009) and estimated blood loss (non-inferiority delta of 25 ml,\n P<\/jats:italic>\n =0.028). The frequency of ventricular ectopy, ST segment changes or blood pressure changes after nasal packing was not significantly different between the two groups.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Phenylephrine in a concentration of 0.5% is not different from 4% cocaine on the quality of vasoconstriction in septoplasty. Given the abuse potential of cocaine and the added administrative burden associated with its handling, phenylephrine might serve as an alternative.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/0019-5049.111844","type":"journal-article","created":{"date-parts":[[2013,5,15]],"date-time":"2013-05-15T02:20:38Z","timestamp":1368584438000},"page":"163-169","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":10,"title":["Phenylephrine as an alternative to cocaine for nasal vasoconstriction before nasal surgery: A randomised trial"],"prefix":"10.4103","volume":"57","author":[{"given":"Sawsan T","family":"AlHaddad","sequence":"first","affiliation":[{"name":"Beachwood Ambulatory Surgicenter, Anesthesiology Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish K","family":"Khanna","sequence":"additional","affiliation":[{"name":"Anesthesiology Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J","family":"Mascha","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Learner Research Institute, Cleveland, OH, USA"},{"name":"Department of Outcomes Research, Anesthesiology Institute, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basem B","family":"Abdelmalak","sequence":"additional","affiliation":[{"name":"Department of General Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-20251205","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/00005537-199901000-00019","article-title":"A preliminary study of cocaine absorption from the nasal mucosa","volume":"109","author":"Liao","year":"1999","journal-title":"Laryngoscope"},{"key":"R3-20251205","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1056\/NEJM198912073212301","article-title":"Cocaine-induced coronary-artery vasoconstriction","volume":"321","author":"Lange","year":"1989","journal-title":"N Engl J Med"},{"key":"R4-20251205","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/j.1365-2044.1985.tb11007.x","article-title":"Severe hypertension during anaesthesia for dacryocystorhinostomy","volume":"40","author":"el-Din","year":"1985","journal-title":"Anaesthesia"},{"key":"R5-20251205","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1001\/archopht.1980.01020030836006","article-title":"Cocaine toxicity during dacryocystorhinostomy","volume":"98","author":"Meyers","year":"1980","journal-title":"Arch Ophthalmol"},{"key":"R6-20251205","first-page":"55","article-title":"The clinical use of cocaine in rhinosurgery: A case-report and a review","volume":"28","author":"Albers","year":"1990","journal-title":"Rhinology"},{"key":"R7-20251205","doi-asserted-by":"crossref","first-page":"797","DOI":"10.7326\/0003-4819-115-10-797","article-title":"Cocaine-induced myocardial infarction in patients with normal coronary arteries","volume":"115","author":"Minor","year":"1991","journal-title":"Ann Intern Med"},{"key":"R9-20251205","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1097\/00000542-198602000-00028","article-title":"Comparison of 4% lidocaine\/0.5% phenylephrine with 5% cocaine: Which dilates the nasal passage better?","volume":"64","author":"Sessler","year":"1986","journal-title":"Anesthesiology"},{"key":"R10-20251205","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1213\/00000539-198410000-00008","article-title":"A suitable substitute for 4% cocaine before blind nasotracheal intubation: 3% lidocaine-0.25% phenylephrine nasal spray","volume":"63","author":"Gross","year":"1984","journal-title":"Anesth Analg"},{"key":"R11-20251205","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1097\/00000542-200003000-00030","article-title":"New York State guidelines on the topical use of phenylephrine in the operating room","volume":"92","author":"Groudine","year":"2000","journal-title":"Anesthesiology"},{"key":"R12-20251205","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1002\/sim.1296","article-title":"Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: Current practice and problems","volume":"21","author":"Pocock","year":"2002","journal-title":"Stat Med"},{"key":"R13-20251205","first-page":"1395","article-title":"Cardiovascular toxicity of cocaine of iatrogenic origin. 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