Abstract
Nasal occlusive dressings are routine after nasal surgeries to arrest hemorrhage, to prevent septal hematoma, and to prevent postoperative adhesions. However, patients describe nasal packing and its removal as their worst experience. Various types of nasal packs are available. Medicated ribbon gauge is the traditional form of nasal pack which consists of an open-mesh cotton as a carrier whereas “Polyvinyl Acetate’ sponge is a compressed dehydrated material, an improvised one which increases in size and compresses blood vessels when rehydrated with normal saline. As Polyvinyl acetate sponge is smooth and spongy, it causes less pain and abrasion while in-situ and removal. This was a prospective comparative study done in tertiary hospital of Nepal. Patients were subjected to either polyvinyl acetate sponge or ribbon gauge nasal pack following nasal surgery. Comparisons were made in terms of pain score, maintenance of hemostasis and wound healing. There were 154 patients in the study with 104 males and 50 females. The pain score when nasal pack was in-situ was similar in both groups whereas it was lesser in the polyvinyl acetate group on its removal. However, bleeding and adhesion were found to be similar. Crust formation was less in polyvinyl acetate group. Six synaechia were noted in ribbon gauge group only. Pain was significantly less during removal of polyvinyl acetate pack.
Highlights
Nasal occlusive dressings are used following nasal surgery to arrest hemorrhage, prevent septal hematoma and to prevent postoperative adhesion and synaechia formation by medialising the middle turbinate and apposing the septal flap.[1,2] An ideal dressing should be easy to insert and remove without causing discomfort
Patient often complains that the removal of nasal packs after nasal surgery is the worst part of their surgical experience.[3,4]
The aim of this study was to compare polyvinyl acetate (PVA) and ribbon gauze (RG) nasal packs in terms of discomfort, hemostasis and its usefulness in preventing complications
Summary
Nasal occlusive dressings are used following nasal surgery to arrest hemorrhage, prevent septal hematoma and to prevent postoperative adhesion and synaechia formation by medialising the middle turbinate and apposing the septal flap.[1,2] An ideal dressing should be easy to insert and remove without causing discomfort. Despite the new improvised materials like hydroxylated polyvinyl acetate (PVA) sponge and various balloon tamponade devices, use of Vaseline or antibiotic-soaked ribbon gauze (RG) is still in practice. A foam polymer of hydroxylated polyvinyl acetate is supposed to be less abrasive and associated with lesser pain than medicated ribbon gauze. The aim of this study was to compare PVA and RG nasal packs in terms of discomfort, hemostasis and its usefulness in preventing complications
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