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Oxidised cellulose powder for haemostasis following sinus surgery: a pilot randomised trial

  • S Al-Shaikh (a1), A Muddaiah (a2), R J Lee (a1) and M F Bhutta (a3)

Abstract

Background:

Haemorrhage is the most common major complication of endoscopic sinus surgery. Post-operative absorbable or non-absorbable nasal packing can cause pain and blockage. Haemostatic powders or gels may prevent this problem. However, when based on factors in the clotting cascade, they induce an inflammatory reaction and can cause post-operative synechiae. Oxidised cellulose powder produces haemostasis without inducing synechiae formation, but has not been trialled for sinus surgery.

Method:

A randomised clinical trial was performed to compare cellulose powder to non-absorbable packing following sinus surgery. Participants were 50 consecutive patients undergoing sinus surgery, 47 of whom completed the study. The main outcome measures were post-operative bleeding, pain scores and synechiae formation.

Results:

Cellulose powder was effective at stopping bleeding, and was associated with less pain than nasal packing, with no evidence of increased synechiae formation.

Conclusion:

Cellulose powder appears to be a good haemostatic agent following sinus surgery. A larger trial would allow more accurate quantification of its effectiveness.

Copyright

Corresponding author

Address for correspondence: Mr Mahmood Bhutta, UCL Ear Institute, 332 Grays Inn Road, London WC1X 8EE, UK E-mail: m.bhutta@doctors.org.uk

References

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1Stankiewicz, JA, Lal, D, Connor, M, Welch, K. Complications in endoscopic sinus surgery for chronic rhinosinusitis: a 25-year experience. Laryngoscope 2011;121:2684–701
2Ramakrishnan, VR, Kingdom, TT, Nayak, JV, Hwang, PH, Orlandi, RR. Nationwide incidence of major complications in endoscopic sinus surgery. Int Forum Allergy Rhinol 2012;2:34–9
3Sieskiewicz, A, Olszewska, E, Rogowski, M, Grycz, E. Preoperative corticosteroid oral therapy and intraoperative bleeding during functional endoscopic sinus surgery in patients with severe nasal polyposis: a preliminary investigation. Ann Otol Rhinol Laryngol 2006;115:490–4
4Albu, S, Gocea, A, Mitre, I. Preoperative treatment with topical corticoids and bleeding during primary endoscopic sinus surgery. Otolaryngol Head Neck Surg 2010;143:573–8
5Yaniv, E, Shvero, J, Hadar, T. Hemostatic effect of tranexamic acid in elective nasal surgery. Am J Rhinol 2006;20:227–9
6Ko, MT, Chuang, KC, Su, CY. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope 2008;118:1687–91
7Panda, N, Verma, RK, Panda, NK. Efficacy and safety of high-concentration adrenaline wicks during functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2012;41:131–7
8Shen, PH, Weitzel, EK, Lai, JT, Wormald, PJ, Ho, CS. Intravenous esmolol infusion improves surgical fields during sevoflurane-anesthetized endoscopic sinus surgery: a double-blind, randomized, placebo-controlled trial. Am J Rhinol Allergy 2011;25:e208–11
9Mohseni, M, Ebneshahidi, A. The effect of oral clonidine premedication on blood loss and the quality of the surgical field during endoscopic sinus surgery: a placebo-controlled clinical trial. J Anesth 2011;25:614–17
10Alimian, M, Mohseni, M. The effect of intravenous tranexamic acid on blood loss and surgical field quality during endoscopic sinus surgery: a placebo-controlled clinical trial. J Clin Anesth 2011;23:611–15
11Suzuki, C, Nakagawa, T, Yao, W, Sakamoto, T, Ito, J. The need for intranasal packing in endoscopic endonasal surgery. Acta Otolaryngol Suppl 2010;563:3942
12Saedi, B, Sadeghi, M, Farschi, S. Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study. J Laryngol Otol 2012;126:380–4
13Wee, JH, Lee, CH, Rhee, CS, Kim, JW. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol 2012;269:897903
14Berlucchi, M, Castelnuovo, P, Vincenzi, A, Morra, B, Pasquini, E. Endoscopic outcomes of resorbable nasal packing after functional endoscopic sinus surgery: a multicenter prospective randomized controlled study. Eur Arch Otorhinolaryngol 2009;266:839–45
15Wormald, PJ, Boustred, RN, Le, T, Hawke, L, Sacks, R. A prospective single-blind randomized controlled study of use of hyaluronic acid nasal packs in patients after endoscopic sinus surgery. Am J Rhinol 2006;20:710
16Miller, RS, Steward, DL, Tami, TA, Sillars, MJ, Seiden, AM, Shete, M et al. The clinical effects of hyaluronic acid ester nasal dressing (Merogel) on intranasal wound healing after functional endoscopic sinus surgery. Otolaryngol Head Neck Surg 2003;128:862–9
17Shoman, N, Gheriani, H, Flamer, D, Javer, A. Prospective, double-blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2009;38:112–18
18Szczygielski, K, Rapiejko, P, Wojdas, A, Jurkiewicz, D. Use of CMC foam sinus dressing in FESS. Eur Arch Otorhinolaryngol 2010;267:537–40
19Beyea, JA, Rotenberg, BW. Comparison of purified plant polysaccharide (HemoStase) versus gelatin-thrombin matrix (FloSeal) in controlling bleeding during sinus surgery: a randomized controlled trial. Ann Otol Rhinol Laryngol 2011;120:495–8
20Vaiman, M, Eviatar, E, Shlamkovich, N, Segal, S. Use of fibrin glue as a hemostatic in endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2005;114:237–41
21Athanasiadis, T, Beule, AG, Wormald, PJ. Effects of topical antifibrinolytics in endoscopic sinus surgery: a pilot randomized controlled trial. Am J Rhinol 2007;21:737–42
22Lawson, JH. The clinical use and immunologic impact of thrombin in surgery. Semin Thromb Hemost 2006;32 (suppl 1):98110
23Weitzel, EK, Wormald, PJ. A scientific review of middle meatal packing/stents. Am J Rhinol 2008;22:302–7
24Valentine, R, Athanasiadis, T, Moratti, S, Hanton, L, Robinson, S, Wormald, PJ. The efficacy of a novel chitosan gel on hemostasis and wound healing after endoscopic sinus surgery. Am J Rhinol Allergy 2010;24:70–5
25Antisdel, JL, West-Denning, JL, Sindwani, R. Effect of microporous polysaccharide hemospheres (MPH) on bleeding after endoscopic sinus surgery: randomized controlled study. Otolaryngol Head Neck Surg 2009;141:353–7
26Antisdel, JL, Matijasec, JL, Ting, JY, Sindwani, R. Microporous polysaccharide hemospheres do not increase synechiae after sinus surgery: randomized controlled study. Am J Rhinol Allergy 2011;25:268–71
27Valentine, R, Wormald, PJ. Nasal dressings after endoscopic sinus surgery: what and why? Curr Opin Otolaryngol Head Neck Surg 2010;18:44–8
28Chalupova, M, Suchy, P, Prazanova, G, Bartosova, L, Sopuch, T, Havelka, P. Local tissue reaction after the application of topical hemostatic agents in a rat partial nephrectomy model. J Biomed Mater Res 2012;100:1582–90

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