Comparison of labetalol and lidocaine in induction of controlled hypotension in tympanoplasty: a randomized clinical trial

Abstract

Objectives

This study aimed to compare the efficacy of labetalol and lidocaine in tympanoplasty surgery, specifically evaluating their impact on hemodynamic changes and perioperative outcomes.

Methods

A randomized controlled trial was conducted with 64 patients scheduled for tympanoplasty. Patients were randomly assigned to receive either 0.5-2 mg/min labetalol or 1.5 mg/kg/h lidocaine 1% to achieve controlled hypotension during surgery. The efficacy of the drugs was assessed by comparing the Mean Arterial Pressure (MAP), surgeon's satisfaction, time to target MAP, bleeding volume, postoperative pain scores, the need for analgesic medication in recovery, sedation, and other additional parameters.

Results

The hemodynamic parameters showed a similar trend over time in both the labetalol and lidocaine groups. The median bleeding volume in the labetalol group (10 cc) was lower than that in the lidocaine group (30 cc), although this difference was not statistically significant (p= 0.11). Similarly, surgeon's satisfaction level, pain intensity, and sedation level in the recovery room did not show statistically significant differences between the two groups (p> 0.05). The duration of surgery, recovery stay, and extubation time also did not significantly differ between the groups. Both medications took approximately the same time (20 min) to reach the target MAP and exhibited comparable hemodynamic responses (p> 0.05).

Conclusion

Both labetalol and lidocaine effectively achieved controlled hypotension during tympanoplasty surgery, thereby improving surgical conditions. The choice of medication should be based on individual patient characteristics and the anesthesiologist's judgment.

Level of evidence: II.

Keywords
Tympanoplasty; Labetalol; Lidocaine; Controlled hypotension; Bleeding

Highlights

Both lidocaine and labetalol effectively achieved the desired hypotension levels.

Both drugs achieved the target blood pressure within a similar time frame.

Both drugs have comparable hemodynamic response in achieving hypotension.

There is a comparable quality of surgical field visualization with both drugs.

The choice of drug does not impact the overall duration of the surgical procedures.