Pre-emptive epinephrine nebulization prior to nasotracheal intubation for mandibular fracture fixation surgeries: Does it really differ? A randomised controlled clinical trial

Introduction: Isolated mandibular fractures as any other fracture are associated with pain and inflammation which possess difficulty for both laryngoscopy and intubation. Nasotracheal intubation is relatively more efficient in individuals with isolated mandibular injuries. Epistaxis is the most common complication of nasal intubation. This study aimed to highlight the role of preoperative usage of epinephrine 1:1000 combined with lidocaine as a nebulization session before induction of anaesthesia as a method to spread vasoconstriction and analgesia. Methods: The patients were randomly assigned to one of two equal groups; nasal Lidocaine drops followed by Oxymetazoline nasal drops (OL as control group) or Epinephrine mixed with Lidocaine as nebulization session (EL as the study group). Our primary measures were to estimate the degree of epistaxis and its effect on intubation time. Results: Lidocaine with epinephrine as a nebulization session prior to NTI has statistically significant less intubation time (37.8 +/- 6.32) versus (42.16 +/- 5.1) in the control group with p-value (0.000028). This correlates with higher incidence of moderate nasal bleeding in OL group (7/60 = 11.66%) versus (4/60 = 6.66%) in EL group and P- value = 0.01. EL mixture has a higher priority of decreasing surgical blood loss. Mean +/- SD measures were (406.86 +/- 89.6) and (468.6 +/- 139), p-value = 0.00026*in EL and OL groups respectively. Conclusion: Despite being time consuming measure. Yet, lidocaine epinephrine nebulization session can be considered as an efficient method for prophylaxis against nasotracheal intubation induced epistaxis, to control intraoperative field bleeding, acts as an adjuvant to control intraoperative pain and protects against postextubation nasal complications.