Background: Bleeding is a mutual problem faced during the surgical operation FESS (Functional Endoscopic Sinus Surgery) which increases the hazard of adjacent vital elements damage by the reduction of the surgeon's range of view. Objective: The current work demonstrated for assessment and comparison among topical saline-adrenaline, cold saline and tranexamic acid as substitutions to local vasoconstrictors on bleeding and quality of the surgical area within FESS. Patients and methods: the present work was a prospective randomized controlled study that was demonstrated on 84 cases with class I &II of ASA (American Society of Anesthesiologists), scheduled for selective FESS exposed to a general anesthesia. The studied Cases were categorized into 3 groups, each one of them consists of 28 cases, during the FESS operation group A used topical tranexamic acid (1000mg diluted in 100ml normal saline) group B used saline-adrenaline (1:20000) and group C used cold saline (2-8°C) for irrigation and packing. Results: it was found that when using of local saline-adrenaline, it led to significant rise in the average pressure of artery (81.3 torr) in first 10 minutes after insert topical packs and corrected by anesthesiologist by hypotensive drugs in comparison with other two groups.saline-adrenaline have an advantage in the reduction in the surgical period (60.6 minutes); which increase the quality of surgical area , surgeon satisfaction and decrease blood dissipation(174 ml) in comparison with the other two studied groups. Conclusions: The use of local saline-adrenaline have an advantage in the reduction in the duration of operation that leading to decrease the blood loss and increase the quality of the surgical field with no complications in the hemodynamics during FESS more than other studied group.