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VOLUME 10 , ISSUE 2 ( May-August, 2017 ) > List of Articles

ORIGINAL ARTICLE

Role of Pterygopalatine Fossa Block in achieving Relatively Bloodless Field during Endoscopic Sinus Surgery

Reji Mathew, Chandrakala Srinivasa, Vinayababu Sathyanarayana, Sindhura Suryanarayana, Pooja Harsha

Keywords : Control of bleeding,Endoscopic sinus surgery,Prospective case-control study,Pterygopalatine fossa

Citation Information : Mathew R, Srinivasa C, Sathyanarayana V, Suryanarayana S, Harsha P. Role of Pterygopalatine Fossa Block in achieving Relatively Bloodless Field during Endoscopic Sinus Surgery. Clin Rhinol An Int J 2017; 10 (2):62-65.

DOI: 10.5005/jp-journals-10013-1309

License: CC BY 3.0

Published Online: 01-08-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim

To study the efficacy of pterygopalatine fossa (PPF) block with 2% xylocaine and 1:80,000 adrenaline on bleeding during endoscopic sinus surgery (ESS).

Materials and methods

Single-blinded prospective comparative study was conducted on patients who underwent bilateral functional endoscopic sinus surgery after obtaining written informed consent. The effect of PPF infiltration was tested by injecting 2% xylocaine with adrenaline on test side, and saline on the control side. The test and the control side were determined by block randomization technique. The surgeon was blinded as to which side the test and control drug was to be given. The surgical field was assessed and graded every 15 minutes on both sides according to Boezaart and Vander Merwe scoring system, and the results were compared and analyzed using Mann–Whitney U test.

Results

Thirty-two patients were included in the study, of whom 59.4% were males. Ethmoidal polyposis was the most common diagnosis (50%). The median computed tomography grade and the endoscopic grade of disease in test side and control side were comparable. The mean blood loss grade on test side was 9.0 ± 3.5 and in control side was 10.9 ± 3.5, and the difference was statistically significant. Significant positive correlation was observed between preoperative endoscopic grade of the disease and blood loss during surgery. A statistically significant correlation was also observed between the vital parameters and blood loss.

Conclusion

Pterygopalatine fossa infiltration with 2% xylocaine and 1:80,000 adrenaline reduces bleeding during ESS.

Clinical significance

This study is pivotal in devising an additional method for providing a clear bloodless operative field which to date is one of the major challenges faced by the otorhinolaryngologist.

How to cite this article

Mathew R, Srinivasa C, Sathyanarayana V, Suryanarayana S, Harsha P. Role of Pterygopalatine Fossa Block in achieving Relatively Bloodless Field during Endoscopic Sinus Surgery. Clin Rhinol An Int J 2017;10(2):62-65.


  1. Role of FESS in chronic sinusitis. Indian J Otolaryngol Head Neck Surg 2006 Apr;58(2):137-140.
  2. An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery. Am J Rhinol 2005 May;19(3): 288-292.
  3. Endoscopic sinus surgery: anatomy, three-dimensional reconstruction, and surgical technique. New York: Thieme; 2005. p. 7-12.
  4. Reduction of intraoperative bleeding during functional endoscopic sinus surgery. Anaesthesiol Intens Ther 2011 Jan-Mar;43(1): 45-50.
  5. Control of bleeding in endoscopic skull base surgery: current concepts to improve hemostasis. ISRN Surg 2013 Jun;2013.
  6. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope 2008 Sep;118(9):1687-1691.
  7. The influence of PEEP and tidal volume on central blood volume. Eur J Anaesthesiol 2006 Nov;23(11):954-961.
  8. Endoneurosurgical hemostasis techniques: lessons learned from 400 cases. Neurosurg Focus 2005 Jul;19(1):1-6.
  9. Bilateral sphenopalatine ganglion block in functional endoscopic sinus surgery under general anaesthesia. Alex J Anaesth Intensive Care 2005 Dec;8(4): 45-53.
  10. Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery?. J Laryngol Otol 2014 Sep;128(9):814-817.
  11. The assessment of correlation between mean arterial pressure and intraoperative bleeding during endoscopic sinus surgery in patients with low heart rate. Otolaryngol Pol 2010 Jul-Aug;64(4): 225-228.
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