Effects of nicardipine and esmolol on regional renal oxygenation and hemodynamics during controlled hypotension in rhinoplasty: A prospective, randomized clinical trial

BACKGROUND: Achieving a bloodless surgical field during rhinoplasty is critical, yet the physiological impact of controlled hypotension (CH) on renal oxygenation remains a concern. This study evaluated the effects of nicardipine and esmolol on regional renal oxygenation and hemodynamics during controlled hypotension in patients undergoing rhinoplasty. METHODS: After ethics approval and trial registration (ClinicalTrials.gov: NCT05430724), 80 adults with ASA I-II status undergoing elective rhinoplasty at a single university hospital were enrolled. Patients were assigned to group N (nicardipine, n = 40) or group E (esmolol, n = 40). Target mean arterial pressure (MAP) was 55 to 65 mm Hg. The primary outcomes were regional renal oxygenation (rSO2) measured using near-infrared spectroscopy and hemodynamics. Secondary outcomes included opioid requirements, renal function tests, and assessor-blinded surgical satisfaction. RESULTS: All 80 randomized patients completed the trial and were included in the final analysis. Repeated-measures analysis showed significant time-dependent changes in MAP and renal rSO2 values, with significant time × group interactions for MAP, right renal rSO2, and left renal rSO2. No prespecified renal desaturation events, defined as a ≥20% decrease from baseline rSO2, occurred in either group. Additional opioid use was significantly higher in group N (P = .001), whereas surgical satisfaction was more favorable in group E (P = .001). Postoperative creatinine and urea values remained within normal limits in both groups. CONCLUSION: In this short-duration rhinoplasty model, esmolol was associated with more favorable hemodynamic control, reduced opioid requirement, and higher surgical satisfaction compared with nicardipine. Although nicardipine was associated with higher regional renal rSO2 values, this finding should be interpreted as an exploratory physiological observation rather than evidence of functional renal protection. No external funding was received for this trial.