Cold Dissection vs Electrocautry on TCR in Septoplasty (TCR)

Impact of "Cold Dissection" vs. "Electrocautery" on the Incidence of TCR During Septoplasty

This study aims to address these gaps by comparing the incidence of TCR during septoplasty performed using cold dissection versus electrocautery, while also incorporating a novel assessment of surgical force.

Study Overview

• Status: Not yet recruiting
• Conditions: Septoplasty Surgeries

Detailed Description

Septoplasty is one of the most commonly performed otorhinolaryngological procedures and is generally considered safe . However, it may be associated with rare but potentially serious autonomic reflexes, most notably the trigeminal cardiac reflex (TCR) . The TCR is a brainstem reflex characterized by sudden parasympathetic activation resulting in bradycardia, hypotension, arrhythmias, or even asystole following stimulation of the trigeminal nerve or its branches. Clinically, TCR is usually defined as a sudden reduction in heart rate exceeding 20% from baseline during trigeminal nerve stimulation . The trigeminal nerve provides rich sensory innervation to the nasal septum, particularly in the posterior septal region and near the sphenopalatine area. Surgical manipulation in these areas during septoplasty can trigger TCR, especially when the stimulus is intense or prolonged . While TCR has been extensively reported in neurosurgical, maxillofacial, and skull base procedures, its occurrence during nasal surgery is increasingly recognized but remains underreported and underinvestigated .

Several factors are believed to influence the incidence and severity of TCR, including the type, intensity, and duration of trigeminal stimulation. Both mechanical stimulation, such as traction, pressure, or fracture of bone and cartilage, and thermal stimulation, such as electrocautery, can activate trigeminal afferents . Experimental and clinical observations suggest that thermal stimulation may produce a stronger and more sustained trigeminal response compared to mechanical manipulation alone, potentially leading to a higher incidence of TCR . Despite the widespread use of electrocautery for dissection and hemostasis during septoplasty, there is limited evidence directly comparing its impact on TCR incidence with that of cold steel dissection techniques. Cold dissection relies primarily on mechanical separation using scissors, chisels, and elevators, avoiding thermal injury to surrounding tissues and neural endings. Whether this difference in stimulus modality translates into a clinically significant difference in TCR incidence has not been systematically evaluatedData analysis will be carried out using SPSS (IBM SPSS Statistics) and/or R.

Continuous variables will be expressed as mean ± standard deviation (SD) when normally distributed, or as median with interquartile range for non- normally distributed data. Categorical variables will be summarized as frequencies and percentages. A p-value of less than 0.05 (two-tailed) will be considered statistically significant. Group comparisons will be conducted using: Independent samples t-test for normally distributed continuous data, Mann-Whitney U test for skewed continuous data, Chi-square test or Fisher's exact test for categorical data.

• Study Type: Observational
• Enrollment (Estimated): 120

Contacts and Locations

• Study Contact: Name: Fatmaelzahraa O Bahr, Lecture; Phone Number: 00201097356769; Email: drfatmabahr85@gmail.com
• Study Contact Backup: Name: Mohamed A Hamed, Professor; Phone Number: +201118560065 00201010509736; Email: mah07@fayoum.edu.eg

Study Locations

• Egypt
  • Al Fayyum, Egypt, 63514
    • Fayoum University hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Randomization and Group Allocation Patients will be randomly allocated into two groups using computer-generated randomization:

Description

Inclusion Criteria:

• Age 18-60 years.
• Indicated for primary septoplasty.
• American Society of Anesthesiologists (ASA) physical status I-II.

Exclusion Criteria:

• History of cardiac arrhythmias or conduction abnormalities.
• Use of beta-blockers, calcium channel blockers, or antiarrhythmic drugs Previous nasal surgery.
• Combined nasal procedures.
• Intraoperative complications requiring deviation from the assigned technique.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Group C (Cold Dissection Group); Septoplasty performed using cold steel instruments only (scissors, elevators, chisels) for flap elevation and spur removal, with avoidance of electrocautery near the septal base.
Group E (Electrocautery Group); Septoplasty performed using monopolar or bipolar electrocautery for dissection near the septal base and posterior septum.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of TCR	Defined as a decrease in heart rate >20% from baseline during surgery	3 hours from induction

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Magnitude of heart rate reduction	reduction of heart rate less than 50 beats/min	3 hours from induction
Intraoperative hypotension or arrhythmias	decrease mean blood pressure less than 60mmgh	3 hours from induction

Collaborators and Investigators

• Sponsor: Fatmaelzahraa Omar Mahmoud Bahr
• Investigators: Principal Investigator: Mohamed A Hamed, Professor, Fayoum University hospital; Study Director: Fatmaelzahraa O Bahr, Lecture, Fayoum University hospital; Study Chair: Mohamed E Khalil, Lecture, Fayoum University hospital

Publications and helpful links

General Publications

• Lapi D, Scuri R, Colantuoni A. Trigeminal Cardiac Reflex and Cerebral Blood Flow Regulation. Front Neurosci. 2016 Oct 20;10:470. doi: 10.3389/fnins.2016.00470. eCollection 2016.
• Ulusoy S, Bayar Muluk N, Scadding GK, Passali GS, Dilber M, Gevaert P, Passali D, Resuli AS, Van Gerven L, Kalogjera L, Prokopakis E, Rombaux P, Hellings P, Cingi C. The intranasal trigeminal system: roles in rhinitis (allergic and non-allergic). Eur Rev Med Pharmacol Sci. 2022 Dec;26(2 Suppl):25-37. doi: 10.26355/eurrev_202212_30479.

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): February 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: February 14, 2026
• First Submitted That Met QC Criteria: February 20, 2026
• First Posted (Actual): February 23, 2026

Study Record Updates

• Last Update Posted (Actual): February 24, 2026
• Last Update Submitted That Met QC Criteria: February 21, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Electrocautery; trigeminal cardiac reflex; Cold Dissection
• Other Study ID Numbers: R803

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No