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RESEARCH PRODUCT

Nasal packing in posterior epistaxis. Comparison of two methods

subject

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Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. Patients and methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In the other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of rebleeding, need for other concomitant measures, blood transfusion and side effects. Results: In patients with inflatable nasal packing, its placement was significantly faster (36±19 s vs 228±102 s; P<.001) and less painful (6.7±1.7 vs 8.3±1.5; P<.001), requiring less analgesia until its removal. Patients with gauze packs showed a lower average incidence of rebleeding (17% vs 26%; P<.001), fewer cases of blood transfusion (15% vs 18%; P<.001) or of other procedures (4% vs 11%; P<.001). The health cost of the latter was also lower (€1,327±€202 vs €1,648±€318; P<.001) and it generated fewer short and long-term complications. Conclusions: The classic posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces health costs in comparison with inflatable balloon packing.