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Nasal packing after routine nasal surgery—is it justified?

Published online by Cambridge University Press:  29 June 2007

Marcelle Von Schoenberg ,
Philip Robinson  and
Rowena Ryan
Marcelle Von Schoenberg*
Affiliation:
From the Ferens Institute, Middlesex Hospital, Cleveland Street Outpatient Building, London W1N 8AA.
Philip Robinson
Affiliation:
From the Ferens Institute, Middlesex Hospital, Cleveland Street Outpatient Building, London W1N 8AA.
Rowena Ryan
Affiliation:
From the Ferens Institute, Middlesex Hospital, Cleveland Street Outpatient Building, London W1N 8AA.
*
Marcelle von Schoenberg, F.R.C.S., ENT Registrar, 14 Jedburgh Street, London SW11 5QB. Tel: 071 228 4314.
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Abstract

Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week.

Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p<0.001).

Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not.

Routine nasal packing, especially with BIPP, would seem difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.

Keywords

Occlusive dressingsnasalcomplicationsMorbidity
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 107 , Issue 10 , October 1993 , pp. 902 - 905
Copyright
Copyright © JLO (1984) Limited 1993

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