An evaluation of effect of pterygopalatine fossa injection with local anesthetic and adrenalin in the control of nasal bleeding during endoscopic sinus surgery.
BACKGROUND
The aim of this study was to determine the effect of pterygopalatine fossa infiltration with lidocaine and adrenalin on bleeding in the surgical field during endoscopic sinus surgery.


METHODS
A prospective blind randomized controlled trial was performed. Fifty-five patients were randomized to receive a unilateral transoral infiltration of the pterygopalatine fossa with 2 mL of 2% lidocaine and 1:80,000 adrenalin. The operating surgeon was blinded as to which side had been infiltrated at the start of surgery. The surgical field was graded on a previously validated surgical field grading scale every 15 minutes with the side being operated on alternated every 30 minutes. The pulse, mean arterial blood pressure, and end-tidal CO2 concentration were monitored with each surgical field observation.


RESULTS
At each individual time point from 30 minutes to 3.5 hours there was a significant difference in surgical grade between injected and noninjected sides in favor of the injected side (p = 0.01). The difference between surgical grades averaged across all time points was slight but significant. The injected side had an overall mean of 2.59 (SE, 0.22) compared with 2.99 (SE, 0.23) for the noninjected side. Heart rate also was found to correlate independently to surgical grade.


CONCLUSIONS
Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.
Wormald
Peter-John
PJ
Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide University, South Australia, Australia.
Athanasiadis
Theodore
T
Rees
Guy
G
Robinson
Simon
S
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002908:Chronic Disease; D004311:Double-Blind Method; D004724:Endoscopy / Q000379:methods; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use; D004844:Epistaxis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects; D009298:Nasal Polyps / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery; D019990:Perioperative Care; D011446:Prospective Studies; D012852:Sinusitis / Q000601:surgery; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000627:therapeutic use
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine