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Mettias B, Karia CT, Irvine E, Conboy P. Comparison of side effects and patient perceptions towards Rapid Rhino and Merocel packs in epistaxis. J Laryngol Otol 2024; 138:642-646. [PMID: 38230503 DOI: 10.1017/s0022215124000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVE Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects. METHODS A prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used. RESULTS A total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used. CONCLUSION Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.
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Affiliation(s)
- Bassem Mettias
- Department of Otorhinolaryngology, University Hospitals of Leicester, Leicester, UK
| | | | - Esmee Irvine
- Department of Otorhinolaryngology, University Hospitals of Leicester, Leicester, UK
| | - Peter Conboy
- Department of Otorhinolaryngology, University Hospitals of Leicester, Leicester, UK
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Ding K, Cong W, Liu Y, Song C, Mi H, Liu C, Ma Y, Shen C. Antibacterial polyurethane foams with quaternized-chitosan as a chain extender for nasal packing and hemostasis. Acta Biomater 2024; 181:249-262. [PMID: 38704113 DOI: 10.1016/j.actbio.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
Endoscopic surgery is an effective and common clinical practice for chronic sinusitis. Nasal packing materials are applied in nasal surgery to prevent hemorrhage and promote wound healing. In this study, a degradable polyurethane foam dressing is successfully developed as a promising nasal packing material with good biocompatibility and antibacterial capability. Specifically, quaternized chitosan (QCS) serves as the crosslinker instead of polyols to offer polyurethane foam (PUF-QCS) antibacterial capability. The PUF-QCS2.0 % (with 2.0 wt% QCS) exhibits satisfactory liquid absorption capacity (19.4 g/g), high compressive strengths at both wet (14.5 kPa) and dry states (7.7 kPa), and a good degradation rate (8.3 %) within 7 days. Meanwhile, PUF-QCS2.0 % retains long-term antibacterial activity for 7 days and kills 97.3 % of S. aureus and 91.8 % of E. coli within 6 hours in antibacterial testing. Furthermore, PUF-QCS2.0 % demonstrates a positive hemostatic response in the rabbit nasal septum mucosa trauma model by reducing hemostatic time over 50.0 % and decreasing blood loss up to 76.1 % compared to the commercial PVA nasal packing sponge. Importantly, PUF-QCS also exhibits a significant antibacterial activity in nasal cavity. This nasal packing material has advantages in post-surgery bleeding control and infection prevention. STATEMENT OF SIGNIFICANCE: The performance of a nasal packing sponge requires good mechanical properties, fast and high liquid absorption rate, effective degradability and strong antibacterial activity. These features are helpful for improving the postoperative recovery and patient healing. However, integrating these into a single polyurethane foam is a challenge. In this study, quaternized chitosan (QCS) is synthesized and used as a chain extender and antibacterial agent in preparing a degradable polyurethane foam (PUF-QCS) dressing. PUF-QCS undergoes partial degradation and exhibits effective broad-spectrum antibacterial activity in 7 days. The reduction of postoperative bleeding and infection observed in the animal experiment further demonstrates that the PUF-QCS developed here outperforms the existing commercial nasal packing materials.
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Affiliation(s)
- Kaidi Ding
- Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China
| | - Wenlong Cong
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Ying Liu
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Changtong Song
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China
| | - Haoyang Mi
- Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China
| | - Chuntai Liu
- Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China
| | - Yuhong Ma
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing 100029, China.
| | - Changyu Shen
- Key Laboratory of Materials Processing and Mold (Zhengzhou University), Ministry of Education, National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China.
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Carrie S, Fouweather T, Homer T, O'Hara J, Rousseau N, Rooshenas L, Bray A, Stocken DD, Ternent L, Rennie K, Clark E, Waugh N, Steel AJ, Dooley J, Drinnan M, Hamilton D, Lloyd K, Oluboyede Y, Wilson C, Gardiner Q, Kara N, Khwaja S, Leong SC, Maini S, Morrison J, Nix P, Wilson JA, Teare MD. Effectiveness of septoplasty compared to medical management in adults with obstruction associated with a deviated nasal septum: the NAIROS RCT. Health Technol Assess 2024; 28:1-213. [PMID: 38477237 PMCID: PMC11017631 DOI: 10.3310/mvfr4028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background The indications for septoplasty are practice-based, rather than evidence-based. In addition, internationally accepted guidelines for the management of nasal obstruction associated with nasal septal deviation are lacking. Objective The objective was to determine the clinical effectiveness and cost-effectiveness of septoplasty, with or without turbinate reduction, compared with medical management, in the management of nasal obstruction associated with a deviated nasal septum. Design This was a multicentre randomised controlled trial comparing septoplasty, with or without turbinate reduction, with defined medical management; it incorporated a mixed-methods process evaluation and an economic evaluation. Setting The trial was set in 17 NHS secondary care hospitals in the UK. Participants A total of 378 eligible participants aged > 18 years were recruited. Interventions Participants were randomised on a 1: 1 basis and stratified by baseline severity and gender to either (1) septoplasty, with or without turbinate surgery (n = 188) or (2) medical management with intranasal steroid spray and saline spray (n = 190). Main outcome measures The primary outcome was the Sino-nasal Outcome Test-22 items score at 6 months (patient-reported outcome). The secondary outcomes were as follows: patient-reported outcomes - Nasal Obstruction Symptom Evaluation score at 6 and 12 months, Sino-nasal Outcome Test-22 items subscales at 12 months, Double Ordinal Airway Subjective Scale at 6 and 12 months, the Short Form questionnaire-36 items and costs; objective measurements - peak nasal inspiratory flow and rhinospirometry. The number of adverse events experienced was also recorded. A within-trial economic evaluation from an NHS and Personal Social Services perspective estimated the incremental cost per (1) improvement (of ≥ 9 points) in Sino-nasal Outcome Test-22 items score, (2) adverse event avoided and (3) quality-adjusted life-year gained at 12 months. An economic model estimated the incremental cost per quality-adjusted life-year gained at 24 and 36 months. A mixed-methods process evaluation was undertaken to understand/address recruitment issues and examine the acceptability of trial processes and treatment arms. Results At the 6-month time point, 307 participants provided primary outcome data (septoplasty, n = 152; medical management, n = 155). An intention-to-treat analysis revealed a greater and more sustained improvement in the primary outcome measure in the surgical arm. The 6-month mean Sino-nasal Outcome Test-22 items scores were -20.0 points lower (better) for participants randomised to septoplasty than for those randomised to medical management [the score for the septoplasty arm was 19.9 and the score for the medical management arm was 39.5 (95% confidence interval -23.6 to -16.4; p < 0.0001)]. This was confirmed by sensitivity analyses and through the analysis of secondary outcomes. Outcomes were statistically significantly related to baseline severity, but not to gender or turbinate reduction. In the surgical and medical management arms, 132 and 95 adverse events occurred, respectively; 14 serious adverse events occurred in the surgical arm and nine in the medical management arm. On average, septoplasty was more costly and more effective in improving Sino-nasal Outcome Test-22 items scores and quality-adjusted life-years than medical management, but incurred a larger number of adverse events. Septoplasty had a 15% probability of being considered cost-effective at 12 months at a £20,000 willingness-to-pay threshold for an additional quality-adjusted life-year. This probability increased to 99% and 100% at 24 and 36 months, respectively. Limitations COVID-19 had an impact on participant-facing data collection from March 2020. Conclusions Septoplasty, with or without turbinate reduction, is more effective than medical management with a nasal steroid and saline spray. Baseline severity predicts the degree of improvement in symptoms. Septoplasty has a low probability of cost-effectiveness at 12 months, but may be considered cost-effective at 24 months. Future work should focus on developing a septoplasty patient decision aid. Trial registration This trial is registered as ISRCTN16168569 and EudraCT 2017-000893-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/226/07) and is published in full in Health Technology Assessment; Vol. 28, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Sean Carrie
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tony Fouweather
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tara Homer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James O'Hara
- Ear, Nose and Throat Department, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Leila Rooshenas
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Alison Bray
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Emma Clark
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Waugh
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Alison J Steel
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Jemima Dooley
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Michael Drinnan
- Honorary affiliation with Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Medical Physics and Clinical Engineering, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kelly Lloyd
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Yemi Oluboyede
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline Wilson
- Bristol Population Health Science Institute, University of Bristol, Bristol, UK
| | - Quentin Gardiner
- Ear, Nose and Throat Department, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Naveed Kara
- Ear, Nose and Throat Department, Darlington Memorial Hospital, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Sadie Khwaja
- Ear, Nose and Throat Department, Manchester Royal Infirmary, Manchester University Foundation NHS Trust, Manchester, UK
| | - Samuel Chee Leong
- Ear, Nose and Throat Department, Aintree Hospital, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sangeeta Maini
- Ear, Nose and Throat Department, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | | | - Paul Nix
- Ear, Nose and Throat Department, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Janet A Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - M Dawn Teare
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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He J, Xiao Q, Shuai Y, Liu X, Zhuang S. Effect of butorphanol-soaked nasal packing after endoscopic nasal surgery: a double-blind, randomized, placebo-controlled trial. Braz J Otorhinolaryngol 2024; 90:101369. [PMID: 38035468 PMCID: PMC10698545 DOI: 10.1016/j.bjorl.2023.101369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE This study was designed to investigate the effect of butorphanol-soaked nasal packing on analgesia and sleep quality in patients undergoing bilateral endoscopic nasal surgery. METHODS Sixty-six patients were enrolled and randomly allocated into three groups: group B1 (butorphanol 0.03mg/kg), group B2 (butorphanol 0.04mg/kg) and group N (control group). The primary outcome was postoperative pain scores evaluated by a Visual Analogue Scale (VAS) at 2h (T1), 8h (T2), 24h (T3) and 48h (T4) after surgery. Secondary outcome was postoperative sleep quality measured using Subjective Sleep Quality Value (SSQV). RESULTS Postoperative VAS scores of butorphanol groups were significantly lower than the control group at T2, T3 and T4. VAS scores at each time point did not differ between groups B1 and B2. On the first and second nights after surgery, SSQV was higher in butorphanol groups than in the control group. There were no significant differences in SSQV1 and SSQV2 between group B1 and group B2. The incidence of respiratory depression, dizziness, agitation and rescue analgesic use did not show difference among three groups. CONCLUSIONS Butorphanol-soaked nasal packing can reduce pain and improve sleep quality after bilateral endoscopic nasal surgery without increasing adverse effects. A concentration of 0.03mg/kg may be appropriate for clinical application. LEVEL OF EVIDENCE Level 1B.
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Affiliation(s)
- Jiamei He
- The First Affiliated Hospital of Shantou University Medical College, Department of Anesthesiology, Shantou City, Guangdong Province, China
| | - Qingyu Xiao
- The First Affiliated Hospital of Shantou University Medical College, Department of Anesthesiology, Shantou City, Guangdong Province, China
| | - Yu Shuai
- The Second Affiliated Hospital of Zunyi Medical University, Department of Anesthesiology, Zunyi, Guizhou Province, China
| | - Xiaoli Liu
- The First Affiliated Hospital of Shantou University Medical College, Department of Anesthesiology, Shantou City, Guangdong Province, China
| | - Shaohui Zhuang
- The First Affiliated Hospital of Shantou University Medical College, Department of Anesthesiology, Shantou City, Guangdong Province, China.
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5
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Weber RK, Sommer F, Heppt W, Hosemann W, Kühnel T, Beule AG, Laudien M, Hoffmann TK, Hoffmann AS, Baumann I, Deitmer T, Löhler J, Hildenbrand T. [Fundamentals and practice of the application of nasal packing in sinonasal surgery]. HNO 2024; 72:3-15. [PMID: 37845539 DOI: 10.1007/s00106-023-01369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVES This paper presents an overview on nasal packing materials which are available in Germany. The current literature is analyzed whether there are robust criteria regarding use nasal packing after sinonasal surgery, whether there are fundamental and proven advantages or disadvantages of products, and what this means in clinical practice. MATERIALS AND METHODS Selective literature analysis using the PubMed database (key words "nasal packing", "nasal tamponade", "nasal surgery", "sinonasal surgery", or "sinus surgery"), corresponding text books and resulting secondary literature. RESULTS AND CONCLUSIONS Because of systematic methodological shortcomings, the literature does not help in the decision-making about which nasal packing should be used after which kind of sinonasal surgery. In fact, individual approaches for the many different clinical scenarios are recommended. In principle, nasal packing aims in hemostasis, should promote wound healing, and should not result in secondary morbidity. Nasal packing materials should be smooth (non-absorbable materials), inert (absorbable materials), and should not exert excessive pressure. Using non-absorbable packing entails the risk of potentially lethal aspiration and ingestion. For safety reasons inpatient control is recommended as long as this packing is in situ. With other, uncritical packing materials and in patients with special conditions, outpatient control could be justified.
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Affiliation(s)
- Rainer K Weber
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.
- Sinus Academy, Karlsruhe, Deutschland.
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - Fabian Sommer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Werner Heppt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Werner Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Heliosklinikum Stralsund, Stralsund, Deutschland
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Achim Georg Beule
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Deutsches Zentrum für Erkrankungen der oberen Atemwege, Münster, Deutschland
| | - Martin Laudien
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel, Kiel, Deutschland
| | - Thomas K Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Anna Sophie Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Ingo Baumann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
| | - Jan Löhler
- Deutscher Berufsverband der HNO-Ärzte e. V., Neumünster, Deutschland
| | - Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Abi Zeid Daou C, Zaytoun G, Hadi U, Fakhri S, Korban Z. The use of different intranasal splints Doyle splints versus Reuter bivalve splints versus no splints in primary septal surgeries: A randomised clinical trial looking at morbidity. Clin Otolaryngol 2024; 49:87-93. [PMID: 37424214 DOI: 10.1111/coa.14080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/25/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE The objective of this study is to compare the morbidity of different types of intranasal splints (Doyle splints and Reuter bivalve splints) with no intranasal splints in primary septal surgeries and concomitant submucosal reduction of the inferior turbinate. DESIGN Randomised clinical trial SETTING: Single-Center trial at a tertiary care facility PARTICIPANTS: In this randomised clinical trial, 123 consecutive patients underwent primary septoplasty with bilateral submucosal reduction of the inferior turbinate, with no other concurrent procedure. Patients were randomised into three groups: Doyle splints, Reuter bivalve splints and patients with no splints placed. MAIN OUTCOME MEASURES Following surgery, the patients were seen at three consecutive visits. During each visit, the Visual Analogue Scale score for headache, nasal obstruction, overall pain and bleeding and an endoscopic score for secretions, oedema and synechiae was filled. RESULTS Patients were randomised into three groups, 42 received Doyle splints, 41 Reuter bivalve splints and 40 had no splints inserted. When comparing the three groups, the first two post-op visits were scheduled significantly earlier in patients with splints (p < .05). The scores from both groups with splints were statistically higher for headache, nasal obstruction and pain, for the first visit only (p < .05). There was no statistical difference between groups when looking at each subset of the endoscopic score, at each visit (p > .05). CONCLUSION Increased post-operative pain, headaches and nasal obstruction scores were encountered in patients who had splints after surgery. However, endoscopic scores were statistically similar across the three groups with no difference in post-operative endoscopic scores at each visit. and no difference was seen in symptom scores and endoscopic scores between patients with different splints.
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Affiliation(s)
- Christophe Abi Zeid Daou
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Georges Zaytoun
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Usamah Hadi
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samer Fakhri
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Otolaryngology and Head and Neck Surgery, University of Texas, Houston, Texas, USA
| | - Zeina Korban
- Department of Otolaryngology and Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Lo WL, Yeh CF. Using Surgicel-wrapped Merocel to reduce pain during the removal of nasal packing. Acta Otolaryngol 2023; 143:984-988. [PMID: 38134221 DOI: 10.1080/00016489.2023.2292754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Merocel is a commonly used material for nasal packing; nevertheless, the majority of patients experience pain when the nasal packing is removed.Aims/Objectives: This study aims to introduce a novel technique for nasal packing using Surgicel-wrapped Merocel. MATERIAL AND METHODS Patients who underwent septoplasty received either Merocel or Surgicel-wrapped Merocel as nasal packing. Clinical complications related to bleeding and subjective symptoms associated with the packing materials were assessed. RESULTS Between 2018 and 2021, a total of thirty-three patients with a deviated nasal septum underwent septoplasty. Among them, eight patients received Merocel nasal packing, while twenty-five patients were treated with the new nasal packing technique involving Surgicel-wrapped Merocel. We observed a significant reduction in pain during removal in the Surgicel-wrapped Merocel group compared to the Merocel group (p = .008). However, no significant differences were noted in other discomforts related to packing or bleeding after removal between these two groups.Conclusions and Significance:Using Surgicel-wrapped Merocel as nasal packing following septoplasty is an effective method to alleviate pain during removal.
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Affiliation(s)
- Wen-Ling Lo
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otorhinolaryngology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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8
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Gilman R, Ganesh Kumar N. Invited Discussion on: Comparison of the Ankaferd Blood Stopper Tampon and the Merocel Nasal Tampon after Septoplasty Surgery. Aesthetic Plast Surg 2023; 47:301-303. [PMID: 36018328 DOI: 10.1007/s00266-022-03073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Robert Gilman
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, Ann Arbor, MI, 48109, USA.
| | - Nishant Ganesh Kumar
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2130 Taubman Center, Ann Arbor, MI, 48109, USA
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9
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Guan S, Zhao T, Ye J, Zhang J. Influence of bilateral nasal packing on sleep oxygen saturation after general anesthesia: A prospective cohort study. Front Surg 2023; 10:1083961. [PMID: 36793309 PMCID: PMC9922837 DOI: 10.3389/fsurg.2023.1083961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/02/2023] [Indexed: 01/31/2023] Open
Abstract
Objective This study aims to evaluate the effect of bilateral nasal packing on sleep oxygen saturation and its influencing factors on the first night after general anesthesia. Method A total of 36 adult patients who underwent bilateral nasal packing with a nonabsorbable expanding sponge after general anesthesia surgery were prospectively studied. All these patients underwent overnight oximetry tests before and the first night after surgery. The following oximetry variables were collected for analysis: the lowest oxygen saturation (LSAT), the average oxygen saturation (ASAT), the oxygen desaturation index of ≥4% (ODI4), and the percentage of time with oxygen saturation below 90% (CT90). Results Among the 36 patients, the incidences of both sleep hypoxemia and moderate-to-severe sleep hypoxemia increased with bilateral nasal packing after general anesthesia surgery. All the pulse oximetry variables we studied deteriorated significantly after surgery: both LSAT and ASAT decreased significantly (P < 0.05), while both ODI4 and CT90 increased significantly (P < 0.05). In a multiple logistic regression analysis, body mass index (BMI), LSAT, and modified Mallampati grade were found to be independently predictive for a larger decrease in LSAT (≥5%) after surgery (all P's < 0.05). Conclusion Bilateral nasal packing after general anesthesia could induce or aggravate sleep hypoxemia, especially in patients with obesity, relatively normal sleep oxygen saturation, and high modified Mallampati grades.
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Affiliation(s)
- Shuwen Guan
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China,Department of Otorhinolaryngology, Head and Neck Surgery, Shenzhen University General Hospital, Shenzhen, China
| | - Tingting Zhao
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Jingying Ye
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Correspondence: Junbo Zhang Jingying Ye
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China,Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China,Correspondence: Junbo Zhang Jingying Ye
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10
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Titirungruang CK, Charakorn N, Chaitusaney B, Hirunwiwatkul P. Is postoperative nasal packing after septoplasty safe? A systematic review and meta-analysis of randomized controlled studies. Rhinology 2021; 59:340-351. [PMID: 34350430 DOI: 10.4193/rhin21.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To systemically review and compare post-septoplasty complications between total nasal packing and other techniques. METHODOLOGY We searched electronic databases (PubMed, Scopus, and Cochrane Library) and additional sources. The most recent search was on November 30th, 2020. Randomized controlled trials (RCTs) comparing adverse events after post-septoplasty nasal packing versus other techniques were included. The outcomes were adverse events, including respiratory distress, oxygen desaturation, pain severity, bleeding, hematoma, sleep disturbance, infection, crusting, epiphora, dysphagia, perforation, adhesion, and residual septal deviation. RESULTS There were 47 studies (4,087 participants) in this systematic review. Nasal packing was more likely to cause adverse events than other techniques. There were significant increases in respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. There were no statistically significant differences in oxygen desaturation, bleeding, hematoma, infection, perforation, and residual septal deviation. Subgroup analysis found that trans-septal suture was less likely to cause post-operative complications compared with total nasal packing. CONCLUSION Nasal packing after septoplasty was more likely to cause adverse events, including respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. Furthermore, there were no benefits of nasal packing in preventing bleeding, hematoma, and residual septal deviation when compared with other techniques. Routine nasal packing after septoplasty should be avoided. Trans-septal suture should be considered instead.
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Affiliation(s)
- C K Titirungruang
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N Charakorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - B Chaitusaney
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Hirunwiwatkul
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Kim SJ, Chang DS, Choi MS, Lee HY, Pyo JS. Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis. Am J Otolaryngol 2021; 42:102389. [PMID: 33482562 DOI: 10.1016/j.amjoto.2020.102389] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty. METHODS PubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case-control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs). RESULTS Thirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024-0.056) than in the no splint group (0.087, 95% CI 0.055-0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups. CONCLUSIONS These findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.
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12
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Seghers N, Ledeghen S, Collet S, Degols JC. Safety of (rhino)septoplasty without nasal packing in routine ENT practice. Eur Arch Otorhinolaryngol 2021; 278:4329-4333. [PMID: 33738566 DOI: 10.1007/s00405-021-06713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This retrospective study assesses the risks and benefits linked to the non-use of nasal packing after a (rhino)septoplasty, compared with post-operative care with anterior nasal packing such as Merocel®. METHODS Complication rates observed during the first week after surgery were compared between groups with and without use of classic nasal packing over a large sample of 534 patients, who had undergone either a closed or open procedure, with bilateral turbinoplasty, and with or without osteotomies. Complications listed include epistaxis, haematoma, impetiginization, septal perforation, hyperalgesia, and dyspnoea. RESULTS No significant difference was observed between the group with and without packing regarding the immediate post-operative complications of epistaxis (4.4% of the cases with nasal packing versus 3% without, p = 0.918) and impetiginization (3% of the cases with nasal packing versus 4.2% without, p = 0.478). The technique used, as well as any osteotomies performed, had no impact on the results. CONCLUSION Non-use of nasal packing after a (rhino)septoplasty is a safe alternative to classic post-operative methods. Provided that there is a rigorous surgical technique and strict clinical control, it should be used as a principal technique in any routine practice due to its safety for patients immediately post-surgery.
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Affiliation(s)
| | - Stéphane Ledeghen
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
| | - Stéphanie Collet
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
| | - Jean-Christophe Degols
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
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13
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Wang D, Liu T, Liao C, Tang G, Tian T, Tian L. Is nasal septal suturing an alternative technique to nasal packing?: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23535. [PMID: 33327302 PMCID: PMC7738143 DOI: 10.1097/md.0000000000023535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial. METHODS We will perform a systematic review of nasal packings effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed. RESULTS This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors. CONCLUSION This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty. OSF REGISTRATION NUMBER:: doi: 10.17605/OSF.IO/WF3GX.
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Affiliation(s)
- Dandan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Ting Liu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Chao Liao
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Guangjun Tang
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Tian Tian
- Hospital of Chengdu University of Traditional Chinese Medicine
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, PR China
| | - Li Tian
- Hospital of Chengdu University of Traditional Chinese Medicine
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14
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Martinez-Monedero R, Danielian A, Angajala V, Dinalo JE, Kezirian EJ. Methodological Quality of Systematic Reviews and Meta-analyses Published in High-Impact Otolaryngology Journals. Otolaryngol Head Neck Surg 2020; 163:892-905. [PMID: 32450783 DOI: 10.1177/0194599820924621] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the methodological quality of intervention-focused systematic reviews (SRs) and meta-analyses (MAs) published in high-impact otolaryngology journals. DATA SOURCES Ovid Medline, Embase, and Cochrane Library. REVIEW METHODS A comprehensive search was performed for SR and MA citations from 2012 to 2017 in the 10 highest impact factor otolaryngology journals. Abstracts were screened to identify published manuscripts in which the authors indicated clearly that they were performing an SR or MA. Applying a modified typology of reviews, 4 reviewers characterized the review type as SR, MA, or another review type. A simplified version of the AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2) tool was used to assess the reporting and methodological quality of the SRs and MAs that were focused on interventions. RESULTS Search and abstract screening generated 499 manuscripts that identified themselves as performing an SR or MA. A substantial number (85/499, 17%) were review types other than SRs or MAs, including 34 (7%) that were literature reviews. In total, 236 SRs and MAs focused on interventions. Over 50% of these SRs and MAs had weaknesses in at least 3 of the 16 items in the AMSTAR 2, and over 40% had weaknesses in at least 2 of the 7 critical domains. Ninety-nine percent of SRs and MAs provided critically low confidence in the results of the reviews. CONCLUSION Intervention-focused SRs and MAs published in high-impact otolaryngology journals have important methodological limitations that diminish confidence in the results of these reviews.
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Affiliation(s)
- Rodrigo Martinez-Monedero
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
| | - Arman Danielian
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Varun Angajala
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Jennifer E Dinalo
- Health Sciences Libraries, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Eric J Kezirian
- USC Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of USC, California, USA
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15
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Ndon S, Spock T, Torabi SJ, Manes RP. Patterns in Pain and Opiate Use after Endoscopic Sinus Surgery. Otolaryngol Head Neck Surg 2020; 162:969-978. [PMID: 32284006 DOI: 10.1177/0194599820915472] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To evaluate postoperative opiate use and patients' opinions regarding pain management after endoscopic sinus surgery (ESS). STUDY DESIGN Case series with planned data collection. SETTING Tertiary referral medical center. SUBJECTS AND METHODS We prospectively evaluated postoperative opiate utilization in adults undergoing ESS over a 2-year period at an academic medical facility. Exclusion criteria included use of nasal packing, intracranial or orbital procedures, tumor surgery, and any use of endoscopic drills. All patients underwent bilateral maxillary antrostomy, total ethmoidectomy, sphenoidotomy, and frontal sinusotomy with or without septoplasty. Patients were discharged with 30 oxycodone-acetaminophen (5-325 mg) and a survey assessing pain and narcotic/nonnarcotic use on postoperative days 0 to 7. RESULTS A total of 64 patients completed surveys. Mean ± SD narcotic use over the 7-day postoperative period was 7.7 ± 7.6 pills. Patients with high narcotic use (>6 pills total) had no differences in demographic or surgical factors from those with low use (≤6 pills) but did report a higher level of postoperative day 1 pain (4.8 ± 1.1 vs 2.0 ± 1.4, P < .001). Narcotic use declined during this period, with <30% of patients requiring narcotics by postoperative day 3. CONCLUSION Our results support reduced opiate prescription and encouragement of nonnarcotic use after ESS without compromising effective pain management.
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Affiliation(s)
- Sifon Ndon
- Department of Otolaryngology, UCSF School of Medicine, San Francisco, California, USA
| | - Todd Spock
- Department of Otolaryngology, Mount Sinai Health, New York, New York, USA
| | - Sina J Torabi
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - R Peter Manes
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Tsai SC, Lai MT, Kao YL, Wu CC. Effect of infiltrating nasal packing with local anesthetics in postoperative pain and anxiety following sinonasal surgeries: a systemic review and meta-analysis. Braz J Otorhinolaryngol 2020; 86:376-382. [PMID: 32127341 PMCID: PMC9422531 DOI: 10.1016/j.bjorl.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/25/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Packing of the nasal cavity has traditionally been used for postoperative bleeding control and decreasing synechia formation in patients undergoing nasal surgeries. Although absorbable nasal packing has been gaining popularity in the recent years, nonabsorbable nasal packing is still often used in nasal surgeries in various parts of the world. It is known to be associated with pain and discomfort especially upon and during removal, and previous reviews have only evaluated the effects of local anesthetic infiltration of nasal packing in septal surgeries. OBJECTIVE To evaluate the effect of infiltrating nasal packing with local anesthetics in postoperative pain and anxiety following sinonasal surgeries MATERIALS AND METHODS: We searched the PubMed and Embase databases from their earliest record to April 27, 2019, randomized controlled trials and prospective controlled trials for review, and included only randomized controlled trials for data analysis. We included studies using topical anesthetics-infiltrated nasal packing following sinonasal surgeries and evaluated the effectiveness compared to placebo packing in pain reduction during postoperative follow up, as well as the effectiveness in anxiety reduction. RESULTS Among 15 studies included for review, 9 studies involving 765 participants contributed to the meta-analysis. In terms of pain reduction, our analysis showed significant standard mean differences regarding effectiveness at postoperative 1, 12, 24 h interval for all surgical groups combined, in the sinus surgery group, as well as during nasal packing removal. There was no consistent evidence to support the effectiveness in anxiety reduction. CONCLUSIONS Our study supports anesthetics infiltration of nasal packing as an effective method in managing pain in patients with nasal packing after sinonasal surgeries. However, the level of evidence is low. More high-quality randomized controlled trials are needed to establish its effectiveness in reducing anxiety. We believe this review is of great clinical significance due to the vast patient population undergoing sinonasal surgeries. Postoperative local hemorrhage remains the greatest concern for ear nose and throat surgeons due to the rich vasculature of the nose and sinuses. Sinonasal packing provides structural support and serves as an important measure for hemostasis and synechia formation. Although absorbable packing has been gaining popularity in the recent years, nonabsorable packing materials are still used in many countries due to lower cost. Infiltration of nasal packing with local anesthetic provides a solution to the discomfort, nasal pressure and nasal pain experienced commonly by the patients as evidenced by our analysis.
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Affiliation(s)
- Shao-Chen Tsai
- Taipei Medical University, Wang Fang Hospital, Department of Otorhinolaryngology, Taipei, Taiwan
| | - Ming-Tang Lai
- Taipei Medical University, Wang Fang Hospital, Department of Otorhinolaryngology, Taipei, Taiwan; Taipei Medical University, School of Medicine, Department of Otorhinolaryngology, Taipei, Taiwan
| | - Yi-Lin Kao
- Taipei Medical University, Wang Fang Hospital, Department of Otorhinolaryngology, Taipei, Taiwan
| | - Chia-Che Wu
- Taipei Medical University, Wang Fang Hospital, Department of Otorhinolaryngology, Taipei, Taiwan; Taipei Medical University, School of Medicine, Department of Otorhinolaryngology, Taipei, Taiwan.
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17
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Fang S, Wei X, Ying L, Zhu L, Cui J, Ma Z, Wang W. Comparative study of nasal septal retainer and nasal packing in patients undergoing septoplasty. Eur Arch Otorhinolaryngol 2019; 276:2251-2257. [PMID: 31076882 DOI: 10.1007/s00405-019-05455-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/25/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Nasal packing is frequently used after septoplasty and some complications caused by nasal packing are unavoidable. A nasal septal retainer has recently been developed. We evaluated the safety and clinical efficacy of the retainer in septoplasty, and the subjective symptoms of patients with the retainer were compared with Merocel nasal packing. METHODS A prospective, randomized, controlled study was performed in patients who had undergone septoplasty. In total, 39 patients were randomized to receive Merocel (n = 17) or the retainer (n = 22) after septoplasty. The deviation of nasal septum and nasal mucosa was evaluated by endoscopy. The clinical efficacy and subjective symptoms were compared using the visual analog scale. RESULTS During the packing/retaining period, the mean scores of headache, nasal obstruction, epiphora, and facial pressure in the retainer group were significantly lower than in the Merocel group (P < 0.05); the mean scores of nasal pain, nasal itching, rhinorrhea, dysphagia, and sleep disturbance in the retainer group were lower than in the Merocel group, but the difference did not reach statistical significance. On the removal of Merocel/retainer, nasal pain was significantly lower in patients with the retainer (P < 0.05). In the retainer group, the incidence of grade 1 bleeding was 45.5%, and grade 0 bleeding was 54.5%. In the Merocel group, the incidence of grade 2 bleeding was 23.5%, grade 1 was 47.1%, and grade 0 was 29.4%. CONCLUSIONS The nasal septal retainer is suitable for use after septoplasty with more beneficial effects than nasal packing.
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Affiliation(s)
- Shengjian Fang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Xian Wei
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Liyun Ying
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Liwei Zhu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Jiawen Cui
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Zhaoxin Ma
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China
| | - Weihua Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, China.
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18
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Kim KS, Yu SC, Han JW, Shim SM, Kwak S, Kim YM, Kim SS. Effect of fentanyl nasal packing treatment on patients with acute postoperative pain after closed reduction of nasal bone fracture: a randomized double-blind controlled trial. J Plast Surg Hand Surg 2019; 53:167-172. [PMID: 30734629 DOI: 10.1080/2000656x.2019.1566738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. METHODS Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel®, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat. RESULTS Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p < .05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p < .05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p > .05). CONCLUSION Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery.
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Affiliation(s)
- Kwan-Sub Kim
- a Department of Anesthesiology and Pain Medicine, Dongkang Medical Center , Ulsan , South Korea
| | - Sung Chul Yu
- b Department of Plastic Surgery, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Jung-Woo Han
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Sung-Min Shim
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
| | - Soohyun Kwak
- d Department of Rehabilitation Medicine, Semin hospital , Seoul , Korea
| | - Yong-Min Kim
- e The Hong Kong University of Science and Technology , Clear Water Bay , Hong Kong
| | - Seong-Su Kim
- c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea
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Kuboki A, Kikuchi S, Asaka D, Onda N, Nakayama T, Kojima H, Otori N. Nasal silicone splints and quilting sutures using a septum stitch device following septoplasty: a prospective comparative study. Eur Arch Otorhinolaryngol 2018; 275:1803-1809. [PMID: 29796742 DOI: 10.1007/s00405-018-4998-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although nasal splints and trans-septal sutures are preferred for septal closure following septoplasty, quilting sutures, also known as continuous mattress sutures, are technically challenging and thus time consuming. Recently, the utility of a novel stitch device was demonstrated for quilting sutures; however, whether it contributes to the technical solution and time management of septal sutures remains unclear. This study aims to quantify the time and cost of septal closure following septoplasty by comparing nasal splints with quilting sutures using the septum stitch device. METHODS We prospectively examined 23 patients who underwent septoplasty and assigned them to the following two groups: group 1, underwent the quilting suture for septal closure following septoplasty; group 2 underwent the nasal silicone splint method. We recorded the total operation time and surgical time for septal closure. Furthermore, we evaluated postoperative symptoms with Visual Analogue Scale (VAS) scores and compared the complication rate. RESULTS We observed no significant difference in the average of total operating time (P = 0.641) and the surgical time for septal closure (P = 0.886). Among postoperative symptoms, only nasal bleeding was significantly worse in group 1 on postoperative day 1 (P = 0.023). In addition, the occurrence of postoperative complications was insignificant between both groups. CONCLUSIONS The septum stitch facilitated safe and easy quilting suturing without significant increase of operation time.
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Affiliation(s)
- Akihito Kuboki
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Shun Kikuchi
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Daiya Asaka
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nobuto Onda
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Tsuguhisa Nakayama
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Nobuyoshi Otori
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
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20
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Kim KS, Yeo NK, Kim SS, Park WS, Kwak SH, Cho SH, Sung GW, Kim HS, Yi SW, Cho HJ. Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial. Ann Otol Rhinol Laryngol 2018. [PMID: 29519133 DOI: 10.1177/0003489418759113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. METHODS One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. RESULTS The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). CONCLUSION Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.
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Affiliation(s)
- Kwan-Sub Kim
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Nam-Kyung Yeo
- 2 Department of Otorhinolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Seong-Su Kim
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Woong-Sub Park
- 3 Department of Preventive Medicine & Public Health, College of Medicine, Catholic Kwandong University, Gangneung, Korea
| | - Su-Hyun Kwak
- 4 Department of Rehabilitation Medicine, Chungdam Hospital, Seoul, Korea
| | - Sang-Hyeon Cho
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gyu-Wan Sung
- 1 Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hae-Sook Kim
- 5 Department of Pharmacy, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang-Wook Yi
- 6 Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Gangneung, Korea
| | - Hae Jun Cho
- 7 Department of Molecular Pharmacology, Physiology, and Biotechnology, Brown University, Providence, Rhode Island, USA
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Menezes AS, Guimarães JR, Breda M, Vieira V, Dias L. Septal and turbinate surgery: is overnight essential? Eur Arch Otorhinolaryngol 2017; 275:131-138. [PMID: 29159751 DOI: 10.1007/s00405-017-4813-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/15/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The performance of septoplasty and turbinate surgery in an outpatient basis is an increasingly established practice, although is still a controversial topic. METHODS Retrospective analysis of 227 patients who underwent septoplasty ± inferior and/or middle turbinoplasty. Demographic, clinical, surgical, and anesthetic data were collected. Our primary outcomes were rates of perioperative complications, prolongation of hospital stay (PHS), unexpected hospital revisits (UHR), or readmissions within 30 days of surgery. RESULTS The UHR rate was 4.8 and 6.6% in the first 48 h and 30 postoperative days, respectively. The main reasons were nasal obstruction, self-limited epistaxis, and gastrointestinal intolerance to the prescribed antibiotic. Four patients required PHS due to nausea or vomiting and asthenia. There were no intraoperative complications, readmissions to the operative room, or hospital readmissions after discharge. The addiction of turbinate procedures was not associated with higher risk of complications. Patients with PHS were younger than those discharged as scheduled. There was no association between complications and comorbidities, gender, ASA classification, revision surgery, surgeon's grading, technique of inferior turbinoplasty, type of nasal packing, duration of anesthesia, and operative time. CONCLUSION The UHR rate of septoplasty performed at our unit is above that recommended for ambulatory procedures, but is within the range previously published and no major complications were seen. Septoplasty and turbinate surgery, including middle turbinate surgery, have a great potential to be undertaken as a day-case procedure, being patient selection the cornerstone of safe and efficient perioperative care.
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Affiliation(s)
- Ana Sousa Menezes
- Department of Otolaryngology-Head and Neck Surgery, Hospital De Braga, Braga, Portugal.
| | - Joana R Guimarães
- Department of Otolaryngology-Head and Neck Surgery, Hospital De Braga, Braga, Portugal
| | - Miguel Breda
- Department of Otolaryngology-Head and Neck Surgery, Hospital De Braga, Braga, Portugal
| | - Vicente Vieira
- Department of Anesthesiology of Hospital De Braga, Braga, Portugal
| | - Luís Dias
- Department of Otolaryngology-Head and Neck Surgery, Hospital De Braga, Braga, Portugal
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