Hemostasis: A Comparative Analysis of Hot Saline and Room Temperature Saline in Sinus Surgery

Objective: To evaluate the efficacy of room temperature Saline irrigation (RTSI) and hot Saline irrigation (HSI) in controlling intraoperative bleeding during functional endoscopic sinus surgery (FESS). Study Design: Quasi-experimental study Place and Duration of Study: Department of Otorhinolaryngology, Combined Military Hospital, Rawalpindi, Pakistan from Jul 2000 to Dec 2022. Methodology: Sixty-two patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery were randomly assigned to two treatment Groups. One Group received 20 mL of 50°C Saline irrigation, and the other received 20 mL of 18°C Saline irrigation, administered every 10 minutes during the procedure. The study assessed the intraoperative bleeding score, average arterial pressure, and duration of the surgical procedure. Results: The Boezaart endoscopic field of view score was significantly better in the Group that received 49°C Saline Group (Median (IQR)= 3.00 (3.00-2.00)) compared to the Group that received 18°C Saline Group (Median(IQR)= 2.00(2.00-1.00)), with a statistically significant p-value of 0.003. Additionally, the operating time was notably shorter in the 49°C Saline Group (114.29 ± 14.86 minutes) as compared to the 18°C Saline Group (124.48 ± 15.13 minutes), with a p-value of 0.010. Total blood loss was significantly lower in the 49°C Saline Group (Median (IQR)= 258.00 (278.00 – 224.00)) compared to the 18°C Saline Group (Median(IQR)= 221 (254.00 – 200.00)), with a p-value of 0.008. Conclusion: Intranasal hot Saline irrigation during functional endoscopic sinus surgery reduces blood loss, shortens operative time, and enhances the quality of the surgical field without affecting intraoperative hemodynamic stability.