Analgesia Clinical Trial
Official title:
The Effect of Local Anesthesia With Lidocaine During Insertion and Removal of Nasal Packing
This study aims to investigate the effect of local nasal anesthesia with lidocaine spray on the insertion of nasal tampons during active nasal bleeding.
Nasal packing has many uses, such as prevention of postoperative bleeding following
endoscopic sinus surgery, stabilization of the nasal septum, prevention of adhesions
following septoplasty, and treatment of active epistaxis1,2.
The utilization of tampons for nasal packing during nasal and sinus surgeries is widely used
and safe. Nasal tampons assist in creating a moist supportive environment for tissue healing
without causing local irritation or foreign body reaction3. The removal is performed after
24-48 hours. On the other hand, there are some disadvantages to the uses of nasal tampons:
trauma to the nasal mucosa, infection of the nose and sinuses, aspiration of part of the
tampon, and even toxic shock syndrome3. One of the most troublesome aspects to the patient
and the clinician is the pain and discomfort during insertion and removal of the tampons3,4.
In our experience, these symptoms are of considerable significance to the patient experience
and satisfaction.
There is a wide range of commercially available nasal packings such as Merocel and Nasopore.
In our practice, Merocel nasal tampons are used, which contain polyvinyl acetate. This type
of material expands upon contact with fluids, and it is not soluble. This product is used at
the end of endoscopic nasal surgeries and in the treatment of active epistaxis, not amenable
to local pressure and without a recognizable source of bleeding. In case of unstoppable
bleeding despite the use of nasal tampons, a nasal balloon is inflated in the nasal cavity.
Its insertion and inflation are associated with patient pain and discomfort.
Lidocaine is a drug commonly used for local anesthesia. It is used for local nasal anesthesia
by a variety of commercially available sprays, atomizers, nebulizers, gels, and ointments.
Lidocaine causes local anesthesia by affecting sodium channels, causing decreased initiation
and conduction of neural impulses. In turn, fewer afferent impulses reach the central nervous
system6. In healthy individuals, side effects are negligible, but it could influence patients
with cardiac infarction. The main side effects of lidocaine are neurological, which could be
of significance in the case of inflamed or damaged tissue because of rapid absorption. The
use of Lidocaine spray (Xylocaine 10%) is commonly available worldwide and is routinely used
in our institution before fiberoptic laryngoscopy.
Previous publications have mentioned the positive effect of local anesthesia during the
removal of nasal tampons5,7. In a recent meta-analysis, local anesthetics were associated
with less pain during the removal of nasal tampons and shortened time of the procedure. Yet,
the authors recognized the need for additional randomized controlled trials7. There are no
previous publications on the effect of local anesthetics on the insertions of nasal tampons
during active nasal bleeding. In the experience of the senior author, for many years, the
application of lidocaine spray 10% before the insertions of nasal tampons for epistaxis was
associated with a significant reduction of pain and discomfort.
This study aims to investigate the effect of local nasal anesthesia with lidocaine spray on
the insertion of nasal tampons during active nasal bleeding. Secondary objectives include the
impact on nasal tampons removal after the cessation of nasal bleeding and after endoscopic
sinus surgery.
Research hypothesis: local anesthesia with lidocaine before the insertion of nasal tampons or
inflatable balloon reduces patients' pain, discomfort, and stress during insertion for the
treatment of active nasal bleeding, and during removal of nasal tampons either
postoperatively or after cessation of epistaxis.
The study population involves 30 patients with spontaneous epistaxis and another 30 patients
who went tampon removal postoperatively in our institution. Recruitment includes patients who
came to the emergency department with active epistaxis and still had active bleeding after
the application of local pressure without an identified source of bleeding, requiring
treatment with tampons or an inflatable balloon. The second group included patients who
require postoperative removal of nasal tampons.
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