Is Pterygopalatine Fossa Injection with Adrenaline an Effective Technique for Better Surgical Field in Fess?

Abstract

Functional endoscopic sinus surgery (FESS) is one of most common surgeries in otorhinolaryngology practice. It is done in the narrow confines of the nasal cavity. Bleeding into the surgical field is a major problem faced by endoscopic surgeons. To assess the effectiveness of pterygopalatine fossa infiltration with lignocaine and adrenaline in controlling surgical field bleeding during endoscopic sinus surgery. A randomized blinded study was done among 68 patients who underwent FESS. Infiltration with 2% lignocaine with 1:80,000 adrenaline was given only on one side and the surgeon was blinded as to which side was infiltrated and he was asked to assess the surgical field using a standard scale. There was statistical significant improvement in surgical field on the infiltrated side ( = 0.001) with almost 25-30% improvement in surgical field on the infiltrated side. The surgical field bleeding also varied with the blood pressure with a positive correlation. There were no complications associated with the procedure. Pterygopalatine fossa infiltration with lignocaine and adrenaline is an effective technique in reducing surgical field bleeding during FESS. It can be combined with nasal decongestion or hypotensive anaesthesia for an optimum surgical field.

The effect of injection of 1:100 000 adrenaline solution in the pterygopalatine fossa on intra-operative bleeding during endoscopic sinonasal surgical procedures in chronic sinusitis: a blinded clinical trial

“…Although some have recommended this technique as an effective way of reducing blood loss during surgery, [2][3][4][11][12][13] we could not find any significant difference in bleeding between the study and control sides ( p = 0.49), similar to the results of Kumar et al 14 and Valdes et al 1 In a review paper by Shamil et al, in 2017, of seven articles, only two demonstrated a decrease in blood volume in the surgical field in the study group. 15 In contrast, Hwang and colleagues reviewed five articles, which were in favour of this method; additionally, the authors declared that the concentration of 1:80 000 adrenaline solution had a better result in comparison to 1:100 000.…”

“…Correction of coagulopathies, avoidance of predisposing medications in the pre-operative period, proper patient positioning, anaesthetic protocol, topical vasoconstriction, and some drugs like beta-blockers, tranexamic acid and desmopressin, are some of the preventive measures used to decrease blood in the surgical field. 2,3 There are limitations of beta-blocker usage in some patients (e.g. those with asthma); in addition, reports of blindness after the intranasal injection of vasoconstrictors, and limited accessibility of systemic and topical haemostatic agents, are encountered in some instances.…”

Role of Pterygopalatine Fossa Block on Intra-Operative Heart Rate and Blood Pressure During Endoscopic Sinus Surgery at a Tertiary Care Centre

“…While in a similar study by R Mathew, 1:80,00 of 2% xylocaine with adrenaline was used, they haven't specified the quantity 1 . In another study by Shenoy VS, 2 ml of 1:80,000 solution of adrenaline with 2% lignocaine 16 . All these studies showed a significant effect of pterygopalatine fossa block in controlling bleeding, corroborating with our findings.…”

The efficacy of bilateral sphenopalatine ganglion block under general anesthesia in trans-sphenoidal endoscopic hypophysectomy

“…The surgery and SPGB through EETA are supported by recent technological advancements, have been increasingly used over the last decade for the treatment of pituitary adenoma. 1,2,[6][7][8][9][10][15][16][17][18][19][20][21][22] The main goal of blood pressure control during ETSS was to achieve a dry surgical field to improve visibility and facilitate the surgical approach without complication. In the current study, the MAP, HR was maintained at target levels, with no significant differences between the two groups but it was non-fluctuated in the SPGB group by adjustment the ventilatory support and balanced anesthesia with no or minimal consumption of hypotensive agents compared to control group.…”

“…So, the injection of local anesthetic with adrenaline around the sphenopalatine ganglion (SPG) to induce vasoconstriction of the sphenopalatine artery, is widely performed after induction of general anesthesia and before the beginning of surgical procedure. 6,7,8,9,10 The sphenopalatine ganglion (SPG); is a large extracranial and one of four parasympathetic ganglia with multiple neural roots, including autonomic, sensory, and motor. SPG is located in the pterygopalatine fossa, posterior to the middle nasal turbinate under a 1-1.5 mm layer of a mucous membrane, connective tissue and anterior to the pterygoid canal.…”