The Effect of Pterygopalatine Fossa Block (PPFB) during Endoscopic Sinus Surgery (ESS) on Intraoperative Bleeding: A Randomized Control Trial

Abstract

Background: Bleeding is the frequent intraoperative complication in most of the surgeries and remains a challenge for the surgeons and anesthesiologists. Major blood loss during FESS is rare but even a small amount of bleeding disturbs the endoscopic surgery field, increases the likelihood of complications, lengthens the time of surgery and results in incomplete surgery. The greater palatine canal (GPC) local injection is used to limit posterior bleeding during sinus surgery. Objective:To study the effect of pterygopalatine fossa block on intraoperative bleeding and operative field optimization during endoscopic sinus surgery.Methods: Prospective double blind randomized control trial. Thirty six patients were recruited in the study who also acted as their own control. PPFB was done only on one side of the nostril and the side was randomized by the lottery; neither the patient nor the operating surgeons were aware of the laterality. Boezaart score was used to quantify the intra-operative blood loss.Results: Blood loss between block group and non-block group was compared. Patients in block group had more stable hemodynamics with no fluctuations, better visibility of the surgical field and decreased blood loss as compared with non-block group. Conclusion:Greater palatine fossa block is a useful adjunct in patients undergoing endoscopic sinus surgery. It provided more stable hemodynamics, good operative conditions by lowering blood loss.

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, 2–4,11–13 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 .…”

“…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.…”

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

“…All these studies showed a significant effect of pterygopalatine fossa block in controlling bleeding, corroborating with our findings. Paudel et al 17 concluded that PPF block provided more stable haemodynamics, good operative conditions by lowering blood loss. Another study showed reduced total blood loss, shortened surgery time and reduced overall blood loss in similar intervention 18 .…”