Comparison of Intraoperative Bleeding During Bilateral Endoscopic Sinus Surgery with or without Pterygopalatine Fossa Block

Background: Intraoperative bleeding is a common problem encountered during endoscopic sinus surgery. Aim: This study aimed to assess the role of pterygopalatine fossa block in reducing the intraoperative bleeding and operative time during bilateral functional endoscopic sinus surgery. Methods: It was a prospective, comparative study. 38 patients requiring bilateral functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis with nasal polyps (CRSwNP) were enrolled. Pterygopalatine fossa (PPF) block was given using 2% xylocaine and 1:2,00,000 adrenaline through greater palatine canal trans-orally on one side only based on lottery. The intraoperative bleeding was graded as per Boezaart and Van Der Merwe scale for endoscopic grading of bleeding on each side. The operative time on each side was also noted. Results: The mean endoscopic grading of intraoperative bleeding on the side of PPF block was 2.06±0.50 and 2.50±0.47 on the contralateral side, with the difference being statistically significant (p value = 0.00). The mean operative time on the side of PPF block was 44.97±12.85 minutes and 51.47±15.35 on the side without the PPF block and the difference was statistically significance (p value – 0.04). Conclusion: The PFF block with 2% xylocaine and 1:2,00,000 adrenaline significantly reduced both intraoperative bleeding and operative time during FESS. It provided a comparatively better visualization of the surgical field consequently reducing the need for frequent cleaning of endoscope and nasal packing to secure hemostasis hence reducing the operative time.