DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20174323

An observational study comparing the effect of sphenopalatine artery block on bleeding in endoscopic sinus surgery

M. N. Shankar, V. Saravana Selvan, Nigil Sreedharan

Abstract


Background: The use of the sphenopalatine artery block to reduce bleeding during FESS, has been a debatable issue. This cross sectional observational study aims to study whether sphenopalatine artery block has any significant effect on bleeding.

Methods: 55 patients coming to the ENT department of Stanley Medical College from 2015–2016 were included in this study. All patients had bilateral nasal sinus disease and endoscopic sinus surgery was performed on both sides. 20 minutes prior to surgery one side was chosen randomly and sphenopalatine artery block was administered via the greater palatine canal approach. A mixture of lignocaine (2%) and adrenaline (1:80000) was used for infiltration. The surgery was done in an alternating fashion where the surgeon would operate for 15 minutes on one side and then moved onto the other side. The field was graded using the Wormald Grading at 30 minute intervals. The results were tabulated and the Wilcoxon Signed Rank Test was done at each time interval to see if there was a statistically significant difference in the grades of bleeding on both sides at each time interval. SPSS version 22.0 was used to analyse the data. Significance level was fixed as 5% (α=0.05).  

Results: It was found that for each time interval up to 120 minutes there was a significant decrease in the bleeding on the blocked side. However after 120 minutes the bleeding on both sides appeared to be same.

Conclusions: Sphenopalatine artery block given prior to surgery will be effective in reducing bleeding in FESS for the first 2 hours after which the effect of the block wears away.


Keywords


FESS, Sphenopalatine, Palatine, Lignocaine, Adrenaline, Bleeding

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References


Gleeson M. Anatomy of Nose and PNS. In: Stammberger H, Valerie JL, eds. Scott Brown’s Otorhinilaryngology Head and Neck Surgery 7th edition Great Britain UK: Hodder Arnold; 2008: 1315-1343

Wormald PJ, Athanasiadis T, Rees G, Robinson S. 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;19:288-92.

Westmoreland EE, Blanton PL. An analysis of the variations in position of the greater palatine foramen in the adult human skull. Anat Rec. 1982;204(4):383-8.

Valdes CJ, Badaai YAI, Bogado M, Samaha M. Does pterygopalatine canal injection with local anaesthetic and adrenaline decrease bleeding during functional endoscopic sinus surgery. J Laryngol Otol. 2014;128:814-7.

Douglas R, Wormald PJ, Pterygopalatine Fossa Infiltration Through the Greater Palatine Foramen: Where to Bend the Needle, Laryngoscope. 2006;116:1255-7.

Salah A, Ismail MD, Hisham MF, Anwar MD. Bilateral Sphenopalatine Ganglion Block in Functional Endoscopic Sinus Surgery under General Anaesthesia, AJAIC. 2005;8:45-54.

Hassan M Ahmed, Ehab H. Abu-Zaid. Role of Intraoperative Endoscopic Sphenopalatine Ganglion Block in Sinonasal Surgery. J Med Sci. 2007;8:1297-303.