TOPICAL EPINEPHRINE VERSUS INFILTRATIVE EPINEPHRINE -WHAT IS SAFE FOR HEMOSTASIS IN ENDOSCOPIC SINUS SURGERY?

Aim: The study intents to compare the safety & efcacy of topical application versus intranasal injection of epinephrine during endoscopic sinus surgery(ESS) under general anaesthesia(GA) Materials and Methods: This is a tertiary hospital based ,1 year prospective study conducted in 200 patients randomly divided into 2 groups,with group I receiving topical application of 1:2000 epinephrine and group II receiving intranasal inltration of 1:1,00,000 epinephrine,within age group of 10-60 years of both sexes who underwent ESS at GGH,Kurnool from January 2022 to December 2022.Intraoperative hemostatic and hemodynamic parameters following topical application and intranasal injection of epinephrine were analyzed Results: There were no signicant hemodynamic changes or electrocardiographic abnormalities following topical application of 1:2000 epinephrine.There was increase in heart rate,Systolic and Diastolic blood pressure and mean arterial pressure following intranasal injection of epinephrine in study population(P<0.001).12% of study population developed electrocardiogram variation in form of sinus tachycardia following local inltration with 1:1,00,000 epinephrine.Using a standardised scale -Fromme-Boezaart grading to assess hemostasis,no statistical difference in the 2 groups was observed(P>0.05) Conclusion: Topical application of 1:2000 dilution of epinephrine gives similar hemostatic effects compared to intranasal inltration of 1: 1,00,000 dilution of adrenaline during ESS,and is safe due to no signicant hemodynamic abnormalities and thus we can avoid the systemic adverse events such as tachycardia,arrhythmia and mean arterial pressure changes due to epinephrine inltration