Title: The effect of Pterygopalatine Canal Injection with Local Anaesthetic and Adrenaline on Bleeding during Functional Endoscopic Sinus Surgery
Authors: Rohit Bhardwaj, MS, Gul Motwani, MS, Rajeev Kumar Verma, Ms Namrata Yadav, Sandeep Trehan
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.95
Abstract
Introduction: Control of bleeding is important for a safe and effective procedure, as it improves visualization of intranasal anatomy & decreases the risk of complications. Mucosal bleeding is increased in presence of inflammation as seen in chronic rhino-sinusitis during FESS. This study was doneto assess the effect of pterygopalatine canal injection with xylocaine and adrenaline on intraoperative surgical field bleeding, surgery duration & overall blood loss during FESS in comparison to opposite side.
Methods: Prospective single blind randomized controlled trial was performed including 30 patients in a tertiary care Centre. Symmetrical chronic rhinosinusitis (based on Lund-Mackay CT Scoring) patients, undergoing FESS were included. Each served his/her own control since injection containing 2 mL of xylocaine with 1:100000 adrenaline was injected in pterygopalatine canal on one side only. Injection side was decided by lottery method for which operating surgeon was kept blind. Surgical field bleeding graded every 15 minutes based on 6point scale used by Boezaart et al. Surgery was completed on one side first. Total blood loss, surgery duration was computed separately for both sides.
Results: 29 out of 30 patients showed beneficial results of pterygopalatine block in terms of improvement in intra operative surgical field bleeding, reducing surgery time & overall blood loss. Average bleeding grade at 45 and 60 minutes on control arm represented by median (interquartile range) 3 (3-3) & 3 (2-3) respectively and on intervention arm 2 (2-2) & 2 (2-2) having P value of < 0.0001for both is statistically significant. Surgery time in intervention arm showed significant improvement in comparison with control side having p value of 0.007. Improvement was noted in overall blood loss favoring intervention arm (p value <.0001).
Conclusion: Injection of the pterygopalatine canal resulted in improvement in surgical field bleeding, shortened surgery time and reduced overall blood loss in intervention arm.
Keywords: Pterygopalatine Canal, Bleeding, FESS, Adrenaline, Local Anaesthetic, Rhinosinusitis, Surgery Duration.
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