Pterygopalatine Fossa Infiltration in Endoscopic Sino-Nasal Surgery: A Prospective Cohort Analysis

Optimization of surgical field for reduction of intraoperative blood loss is crucial in endoscopic sino-nasal surgery. One of the methods described is infiltration of pterygopalatine fossa (PTF) with local anesthetic agent and vasoconstrictor. This study aims to analyze the outcomes of PTF infiltration during endoscopic sino-nasal surgery under general anesthesia (GA) for benign pathology.

This prospective cohort study was conducted in a tertiary healthcare center on cases undergoing sino-nasal surgery under GA for benign pathology. 2 ml of 2% lignocaine with 1: 80,000 adrenaline solution was infiltrated into PTF through greater palatine canal prior to endoscopic sino-nasal surgery. Pre- and postprocedure mean arterial pressure (MAP) and heart rate (HR) were noted. MAP and HR were monitored every 15 min throughout the surgery along with grade of surgical field. The intraoperative parameters, blood loss, postoperative pain score, and procedure-related complications were assessed for appropriate analysis.

Forty-three cases were included in the study. No significant effect of PTF infiltration was seen on MAP and HR. The mean grade of surgical field was 2.21, and mean intraoperative blood loss was 32.79 mL. There was a positive direct correlation between the grade of surgical field and intraoperative blood loss. Pain score in the immediate postoperative period ranged from 0 to 3 with none requiring rescue analgesia in the first 6 h. Minor, transient procedure-related complications occurred in 5 cases.

PTF infiltration is a simple, inexpensive, safe, and effective adjuvant procedure that provides an acceptable surgical field in endoscopic sino-nasal surgery.