Management of intractable epistaxis in a tertiary care referral hospital: an observational study

Background: The aim of this study is to evaluate the effectiveness of sphenopalatine artery ligation/ cauterisation as a surgical intervention in control of refractory epistaxis and achieving haemostasis. Methods: The study was done with patients in the Department of ENT, Head and Neck surgery Health care hospital and out station referrals from institution’s outreach clinics, for a period of 2 years (May 2020-April 2022).  Patients with recurrent epistaxis, not controlled by digital pressure, anterior packing (ribbon gauze/ merocele) or postnasal packing were taken up for emergency endoscopic sphenopalatine artery ligation/cauterisation under general anaesthesia. Effectiveness of this technique was established by routine endoscopic follow up of these patients over a period of 6 months post procedure.   Results: Out of a total of 55 patients who presented with recurrent epistaxis, 8 patients settled down with conservative management (digital pressure/external ice pack application), 18 patients settled down with anterior nasal packing, 12 patients settled down with anterior and posterior nasal packing and 17 patients required sphenopalatine artery ligation/cauterization. None of these postop patients had any further episodes of nasal bleed. Conclusions: Sphenopalatine artery ligation has proven to be an effective measure in control of intractable refractory epistaxis when compared to therapeutic embolization or other procedures.