title: Effect of greater palatine canal injection on estimated blood loss during endoscopic sinus surgery.
abstract: OBJECTIVE
  We compare estimated blood loss (EBL) during endoscopic sinus surgery (ESS) between patients receiving transoral greater palatine canal (GPC) and transnasal infiltration (combined group) to patients receiving only transnasal infiltration (control group). CT stage, endoscopic stage, revision surgery, presence of polyps, degree of resident involvement, and operative time (OT) are also evaluated.
  
  
  METHODS
  Injection with 1% lidocaine with 1:100,000 epinephrine was performed through the GPC and transnasally in the "combined" study group (20 patients) and only transnasally in the control group (22 patients). Charts, operative reports, and CT scans were reviewed and demographic data as well as pertinent information collected. Data analysis was performed using SPSS Version 16 (SPSS Inc., Chicago, Illinois).
  
  
  RESULTS
  Twelve females and 8 males underwent combined injections and 16 males and 6 females received transnasal injections only. Average ratio of EBL to OT was 2.9 mL/min for the combined group and 4.1 mL/min for the control group (p=0.05). Presence of polyps and revision surgery lead to a statistically significantly higher EBL (p<0.05). Increased EBL and OT were noted with higher endoscopic and CT stages. No complications were reported.
  
  
  CONCLUSIONS
  Increased endoscopic and CT stages, presence of polyps, and revision surgery may all lead to greater EBL in ESS. Although there was a trend towards decreased EBL in the combined group, this however did not reach statistical significance. Combined injection through the GPC and nasal cavity appears to be a safe method to decrease EBL during ESS.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ, USA. Electronic address: jean.anderson.eloy@gmail.com.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.forename: Olga
authors.initials: O
authors.lastname: Kovalerchik
authors.forename: Michael
authors.initials: M
authors.lastname: Bublik
authors.forename: Jose W
authors.initials: JW
authors.lastname: Ruiz
authors.forename: Roy R
authors.initials: RR
authors.lastname: Casiano
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000601:surgery; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies