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 (rSO 2 ) 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 rSO 2 values, with significant time × group interactions for MAP, right renal rSO 2 , and left renal rSO 2 . No prespecified renal desaturation events, defined as a ≥20% decrease from baseline rSO 2 , 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 rSO 2 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.