Abstract

Bleeding is a common intraoperative complication in most of the surgeries and remains a challenge for the Surgeons. Despite the availability of many techniques, there is no definite method for controlling bleeding during endoscopic nasal surgeries. Objective: In this study, we evaluated the effectiveness of pterygopalatine fossa infiltration with lignocaine and adrenaline in controlling surgical field bleeding during endoscopic nasal surgery. Methods: Comparative observational study conducted in Department of ENT (Ear- Nose-Throat) of a tertiary care hospital. All patients who were diagnosed with chronic sinusitis, bilateral sinonasal polyposis, bilateral inferior turbinate hypertrophy supported by nasal endoscopy and computed tomography were considered for the study after fulfilling the inclusion and exclusion criteria. The effect of Pterygopalatine fossa infiltration was tested by injecting 2 mL of xylocaine with 1:100000 adrenaline in pterygopalatine canal on one side (test side), and saline on the control side. The surgical field was assessed and graded every 15 minutes on both sides according to Boezaart and Vander Merwe scoring system. Result: In our study, among the 22 patients who were infiltrated, 19 patients (86%) showed surgical field improvement on the infiltrated side, 3 patients (14%) had similar fields on both side (infiltrated and non-infiltrated side) and none of the patients had lesser bleed on the saline infiltrated side. The grading scale of surgical field was done using a scale called Boezaart and van der Merwe scale and the result was significantly better on the infiltrated side. (p value <0.001). Conclusion: This study finds a significant difference in surgical field bleeding, favouring the injection side. Since it is a simple technique with minimal complications, it can be routinely incorporated in all endoscopic nasal surgery.

Description