What is the most appropriate hemostatic material during pediatric adenoidectomy? A prospective comparative randomized double-blinded controlled study

OBJECTIVES:To evaluate the effect of different hemostatic materials used in adenoidectomy operations to improve the quality of life with the most negligible hazardous impact on pediatric health. STUDY DESIGN:a prospective, case-series, randomized, controlled, double-blinded study. SETTING:All adenoidectomy surgeries were performed between September 2016 to December 2019 at tertiary referral institutions. PATIENTS AND METHODS:519 patients were included in five groups. Adenoidectomy was performed under general anesthesia, with the following hemostatic procedures: adrenaline, tranexamic acid, hydrogen peroxide, xylometazoline, and saline (as a control group). The five groups were compared regarding the intraoperative blood loss, surgery duration, need for more hemostatic steps, postoperative reactionary and secondary bleedings, postoperative pain and halitosis, and one-year outcome. RESULTS:The four procedures were effective in reducing the blood loss by 19.86%, 11.7%, 30.95%, and 18.91%, respectively, in comparison to the control group. The surgical duration was reduced by 27.65%, 17.86%, 48.11%, and 23.88%, respectively. The need for other hemostatic steps was the least in the hydrogen peroxide group. There was no significant difference between the five groups regarding reactionary bleeding, secondary bleeding, one-week pain, one-month pain, one-month halitosis, and one-year complications. On the other side, hydrogen peroxide had the least one-week halitosis and first-day pain among the five groups. Also, it had the least intraoperative blood loss and surgery duration. CONCLUSIONS:Hydrogen peroxide showed to be the best choice to control hemostasis during an adenoidectomy. It can decrease blood loss and surgery duration with less need for other hemostatic steps. It can improve the patient's quality of life without significant postoperative complications. Xylometazoline was studied for the first time as a hemostatic material during adenoidectomy with good satisfying results.