J Rhinol.  2023 Mar;30(1):31-36. 10.18787/jr.2023.00005.

Comparison of Outcomes After Septoplasty With Non-Absorbable or Biodegradable Synthetic Polyurethane Foam Nasal Packing With a Focus on Pain and Cardiac Factors

• An JS
• Kim DH
• Kim SW
• Kim SW
• Lee IH

• KMID: 2540855
• DOI: http://doi.org/10.18787/jr.2023.00005

Abstract

Background and Objectives
We compared pain levels, cardiovascular parameters, and complications according to whether patients underwent nasal packing with non-absorbable or biodegradable materials.
Methods
Patients who underwent septoplasty from May 2015 to April 2020 were retrospectively reviewed. Numeric rating scale (NRS) scores for pain, blood pressure, and heart rate were measured three times (immediately after surgery, 6 hours later, and on postoperative day [POD] 1). We collected data on complications, including postoperative bleeding, septal hematoma, adhesions, septal perforation, and the recurrence of septal deviation.
Results
In total, 200 patients underwent septoplasty, of whom 100 underwent nasal packing with Merocel and 100 underwent packing with Nasopore. The summed NRS scores over the three time points did not differ significantly between the groups. The NRS scores at 6 hours after surgery were highest in both groups. The systolic and diastolic blood pressure and the heart rate immediately after surgery were significantly higher than before surgery in both groups. The blood pressure and heart rate at 6 hours after surgery and on POD 1 did not differ significantly from those before surgery in either group. The incidence of sleep disturbance, postoperative bleeding, septal hematoma, adhesions, septal perforation, and recurrence of septal deviation did not differ significantly between the two groups.
Conclusion
Although the level of postoperative pain and the cardiovascular parameters changed over time, we found no significant differences in pain, blood pressure, heart rate, or the complication rate according to whether patients underwent nasal packing with Nasopore or Merocel.

Keyword

Septoplasty; Nasopore; Merocel; Nasal septum; Postoperative pain

Figure

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  Fig. 1. Pain levels and cardiovascular parameters in the two groups. A: NRS pain scores. B: Systolic blood pressure. C: Diastolic blood pressure. D: Heart rate. NRS, numeric rating scale; SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate.

Reference

References

1. Ardehali MM, Bastaninejad S. Use of nasal packs and intranasal septal splints following septoplasty. Int J Oral Maxillofac Surg. 2009; 38(10):1022–4.

2. Kim JS, Kwon SH. Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis. Laryngoscope. 2017; 127(5):1026–31.

3. Dadgarnia M, Meybodian M, Karbasi A, Baradaranfar M, Atighechi S, Zand V, et al. Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial. Eur Arch Otorhinolaryngol. 2017; 274(9):3513–8.

4. Yadav K, Ojha T, Gakhar S, Sharma A, Singhal A, Kataria V. Effectiveness of nasal packing in trans-septal suturing technique in septoplasty: a randomized comparative study. Indian J Otolaryngol Head Neck Surg. 2019; 71(Suppl 3):1765–9.

5. Mane RS, Patil B, Mohite A. Comparison of septoplasty with and without nasal packing and review of literature. Indian J Otolaryngol Head Neck Surg. 2013; 65(Suppl 2):406–8.

6. Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013; 79(4):471–4.

7. Certal V, Silva H, Santos T, Correia A, Carvalho C. Trans-septal suturing technique in septoplasty: a systematic review and meta-analysis. Rhinology. 2012; 50(3):236–45.

8. Yilmaz MS, Guven M, Elicora SS, Kaymaz R. An evaluation of biodegradable synthetic polyurethane foam in patients following septoplasty: a prospective randomized trial. Otolaryngol Head Neck Surg. 2013; 148(1):140–4.

9. Stevens RW. Nasal packing; the rubber pneumatic pack. AMA Arch Otolaryngol. 1951; 54(2):191–4.

10. von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery--is it justified? J Laryngol Otol. 1993; 107(10):902–5.

11. Samad I, Stevens HE, Maloney A. The efficacy of nasal septal surgery. J Otolaryngol. 1992; 21(2):88–91.

12. Fairbanks DN. Complications of nasal packing. Otolaryngol Head Neck Surg. 1986; 94(3):412–5.

13. Kim YS, Kim YH, Kim NH, Kim SH, Kim KR, Kim KS. A prospective, randomized, single-blinded controlled trial on biodegradable synthetic polyurethane foam as a packing material after septoplasty. Am J Rhinol Allergy. 2011; 25(2):e77–9.

14. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med. 2010; 3:47–57.

15. Alexabnder JL, Hill RG. Postperative pain control. Hoboken, NJ: Blackwell Scientific Publishing;1987.

16. Ocalan R, Akin C, Disli ZK, Kilinc T, Ozlugedik S. Preoperative anxiety and postoperative pain in patients undergoing septoplasty. B-ENT. 2015; 11(1):19–23.

17. Ploghaus A, Narain C, Beckmann CF, Clare S, Bantick S, Wise R, et al. Exacerbation of pain by anxiety is associated with activity in a hippocampal network. J Neurosci. 2001; 21(24):9896–903.

18. Kayabasi S, Cayir S, Hizli O. The effects of intraday operation time on pain and anxiety of patients undergoing septoplasty. Braz J Otorhinolaryngol. 2021; 87(3):310–4.

19. Gadkaree SK, Shaye DA, Occhiogrosso J, Lee LN. Association between pain and patient satisfaction after rhinoplasty. JAMA Facial Plast Surg. 2019; 21(6):475–9.

20. Williams HL. The clinical physiology and pathology of the nasal airways and of their adjoining air-filled cavities. Ann Otol Rhinol Laryngol. 1970; 79(3):513–8.

21. Massumi RA, Sarin RK, Pooya M, Reichelderfer TR, Fraga JR, Rios JC, et al. Tonsillar hypertrophy, airway obstruction, alveolar hypoventilation, and cor pulmonale in twin brothers. Dis Chest. 1969; 55(2):110–4.

22. Cook TA, Komorn RM. Statistical analysis of the alterations of blood gases produced by nasal packing. Laryngoscope. 1973; 83(11):1802–9.

23. Yildirim A, Yasar M, Bebek AI, Canbay E, Kunt T. Nasal septal suture technique versus nasal packing after septoplasty. Am J Rhinol. 2005; 19(6):599–602.

24. Gal TJ, Cooperman LH. Hypertension in the immediate postoperative period. Br J Anaesth. 1975; 47(1):70–4.

25. Taheri A, Farahani MM, Saeedi M, Banaei-Boroujeni S, Khosravi MH, Hosseini SM. Comparing cardiac complications of bilateral nasal packing versus bilateral packing with airway after septoplasty; a randomized clinical trial. J Biochem Tech. 2019; 2:95–9.

26. Zayyan E, Bajin MD, Aytemir K, Yılmaz T. The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway. Laryngoscope. 2010; 120(11):2325–30.

27. Baxandall ML, Thorn JL. The nasocardiac reflex. Anaesthesia. 1988; 43(6):480–1.

28. Betlejewski S, Betlejewski A, Burduk D, Owczarek A. [Nasal-cardiac reflex]. Otolaryngol Pol. 2003; 57(5):613–8. Polish.

29. Haldar R, Kaur J, Bajwa SJ. Nasocardiac reflex during aspiration and injection through a nasogastric tube: an infrequent occurrence. Indian J Crit Care Med. 2015; 19(4):237–9.

30. Banglawala SM, Gill M, Sommer DD, Psaltis A, Schlosser R, Gupta M. Is nasal packing necessary after septoplasty? A meta-analysis. Int Forum Allergy Rhinol. 2013; 3(5):418–24.