Merocel Packing Research Articles

Rapid Rhino versus Merocel nasal packs in septal surgery

To compare Rapid Rhino and Merocel packs for nasal packing after septoplasty, in terms of patient tolerance (both with the pack in place and during removal) and post-operative complications. Thirty patients (aged 18-40 years) scheduled for septoplasty were included. Following surgery, one nasal cavity was packed with Rapid Rhino and the other one with Merocel. Patients were asked to record pain levels on a visual analogue score, on both sides, with the packs in situ and during their removal the next day. After pack removal, bleeding was compared on both sides. The mean ± standard deviation pain score for the Rapid Rhino pack in situ (4.17 ± 1.78) was less than that for the Merocel pack (4.73 ± 2.05), but not significantly so (p = 0.314). The mean pain score for Rapid Rhino pack removal (4.13 ± 1.76) was significantly less that that for Merocel (6.90 ± 1.67; p = 0.001). Bleeding after pack removal was significantly less for the Rapid Rhino sides compared with the Merocel sides (p <0.05). Rapid Rhino nasal packs are less painful and cause less bleeding, compared with Merocel packs, with no side effects. Thus, their use for nasal packing after septal surgery is recommended.

The Effect of Prilocaine or Levobupivacaine Infiltration on Pain during Nasal Packing Removal

The aim of this study was to evaluate the efficacy of rehydration of Merocel nasal packs with prilocaine or levobupivacaine on reducing pain and discomfort of nasal packing removal in patients who had undergone septoplasties or endoscopic sinus surgery. Prospective clinical study. Setting. Tertiary referral center. This prospective study was conducted on 72 patients, aged 18 to 55 years, who had undergone septoplasty, bilateral functional endoscopic sinus surgery, or both. The patients were divided into 2 groups: prilocaine group (group P, n = 36), who received 2.5 mL of 2% prilocaine, and levobupivacaine group (group L, n = 36), who received 2.5 mL of levobupivacaine hydrochloride dilution. These solutions were diluted with 2.5 mL saline to a final volume of 5 mL, which was then injected into the Merocel packing 15 minutes before removal of the pack. In both groups, 5 mL of saline was injected into the packing in the contralateral nostril as a control 15 minutes before removal of the pack. Visual analog score (VAS) and the Ramsay sedation score were recorded. Statistically significant differences were found in VAS and Ramsay sedation scale scores of levobupivacaine and prilocaine groups compared to controls. No significant difference was noted between the groups in terms of levobupivacaine and prilocaine. Levobupivacaine or prilocaine infiltration before removal of nasal packs in patients who undergo septoplasties or endoscopic sinus surgery can decrease discomfort and improve patient tolerability.

Technical tutorial: how to pack a nose with bismuth iodoform paraffin paste gauze safely and effectively

The current primary treatment for epistaxis in accident and emergency departments is the insertion of Merocel packs. If these are properly inserted, but fail to control bleeding, it is necessary...

An evaluation of Merocel and Series 5000 nasal packs in patients following nasal surgery: a prospective randomised trial

The primary objective of this study was to compare postoperative pain levels between Merocel and Series 5000 nasal packs. A prospective randomised, single blind, paired control trial. A single consultant in two tertiary Otolaryngology units. Twenty-four adults, ASA 1, who underwent septoplasty, endoscopic sinus surgery or both, were considered after exclusion criteria were applied: bleeding abnormalities, patients taking anticoagulant medications and any significant co-morbidity requiring admission beyond 24-h postoperatively. Twenty-one patients were randomly assigned to have one side of their nose packed with Merocel pack and the other with Series 5000 overnight. The difference in pain levels, using a visual analogue scale, both with the pack in situ and on removal. In 20 patients, the mean pain scores while the packs were in situ were 3.78 for Merocel and 3.62 for Series 5000 and was not found to be significantly different (P = 0.65. 95% CI = -0.57-0.89). The mean pain score on removal of the Merocel pack was five and for the Series 5000 was 3.08. The Series 5000 pack was significantly less painful than Merocel on removal (P < 0.0001. 95% CI = 1.11-2.7). Both were equally effective in their stability and haemostatic effect. Both the Merocel and Series 5000 packs are effective packs regarding haemostasis and have equivalent pain levels while in situ. However, the Series 5000 pack was significantly less painful on removal of the pack.

Endoscopic intranasal reduction of the orbit in isolated blowout fractures

Conclusion. Endoscopic intranasal reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel® packing, provided good functional results and definite advantages. We suggest that these techniques are another surgical alternative for isolated orbital floor or medial wall blowout fractures that do not accompany any associated fractures of the orbital rim. Objectives. Extended applications of endoscopic sinus surgery have reported endoscopic intranasal reduction or reconstruction of the orbital wall with good functional and cosmetic results. We present our experience with endoscopic intranasal reduction of the orbit in isolated orbital floor and/or medial wall blowout fractures, treated by reduction of the orbital floor with a detachable temporary balloon, or of the medial orbital wall with a silastic sheet and Merocel packing. Subjects and Methods. Floor reduction: After creating a wide middle meatal antrostomy, herniated orbital contents and fracture-displaced floor are mobilized and reduced. The orbital floor is supported by a saline filled balloon, which is connected with an infant feeding catheter and passed through the middle meatal antrostoma. After confirming the reduction of the orbital floor by postoperative CT, the catheter is ligated and cut in short to keep it in the nasal cavity. Medial wall reduction: After completing an intranasal ethmoidectomy, herniated orbital contents and fractured lamina papyracea are mobilized and reduced. The shape of the medial orbital wall is fixed by a silastic sheet and Merocel® packing saturated with an antibiotic solution. Surgery was performed when the eye function could be accurately assessed, usually at 7 to 10 days following the injury. Temporary supporting of the orbital wall with a detachable temporary balloon, or a silastic sheet and Merocel® packing was removed 4 weeks after surgery in the out-patient clinic. Results. We have experienced 40 cases of endoscopic intranasal reduction of the orbit in blowout fractures. CT scan confirmed isolated orbital floor fracture in 11 patients, isolated medial wall fracture in 17 patients, and combined fractures of the orbital floor and the medial wall in 12 patients. Twenty five patients had diplopia, 20 patients had limitation of eye movement, and 14 patients developed enophthalmos. Thirty three of the 40 patients recovered completely without any residual eye symptoms or complications.

The evaluation of the use of a delayed surgical obturator in dentate maxillectomy patients by considering days elapsed prior to commencement of postoperative oral feeding

As a prosthodontic treatment for a maxillectomy patient in the initial postoperative period, immediate surgical obturators during surgery have been advocated to restore and maintain the patient's oral function to a reasonable level. However, these may fit poorly because they are fabricated using preoperative casts. The purpose of this study was to determine the comparative usefulness of a delayed surgical obturator. During the period from 2000 to 2004, 29 patients underwent prosthodontic treatment after maxillectomy. Twenty-three patients who were dentate postoperatively and were treated with polyvinyl acetal (Merocel) packing and a delayed surgical obturator were included in this study. Patients who were edentulous postoperatively, who were treated with an immediate surgical obturator or whose data were incomplete were excluded. The records of 23 patients were reviewed to determine the usefulness of using a delayed surgical obturator by counting days required to start postoperative oral feeding. The median of days elapsed prior to commencement of postoperative oral feeding was compared with data from a study by Lapointe et al (1996). In the Lapointe et al study, the median days elapsed prior to beginning a clear fluid diet was 2 in the group using immediate surgical obturators. The data were analyzed using the 1-sample Wilcoxon signed rank test (alpha=.05). Days elapsed prior to commencement of postoperative oral feeding were less than those reported previously. Patients with Merocel packing began oral feeding, on average, 1.48 days after the maxillectomy. The median number of days elapsed prior to commencement of postoperative oral feeding was 1. This time was earlier than the 2 days for the Lapointe et al study (P=.0074). No major postoperative care complications occurred among the maxillectomy patients treated with a delayed surgical obturator. Delayed surgical obturators were successful in terms of the postoperative care of dentate maxillectomy patients and did not increase patient discomfort during early rehabilitative management.

The Use of Tetracaine 0.25% Solution in Nasal Packing Removal

The aim of this study was to evaluate efficacy of Merocel nasal package rehydration with tetracaine 0.25% solution, in reducing discomfort of nasal packing removal after septoplasty. A prospective study was conducted on patients undergoing pure septoplasty. Merocel packing was applied in each side and kept for 2 days postoperatively. Merocel was rehydrated before removal, with 4 mL of saline on one side and 4 mL of tetracaine 0.25% solution on the other side. Patients were asked to evaluate severity of pain during nasal packing removal on each side by a visual analog scale. Patients' data, pain score, and potential complications were placed in a database and statistically assessed. Our series consisted of 141 persons. Statistical analysis showed significant lower pain score in favor of the tetracaine group. No tetracaine complications or side effects occurred. Merocel packing rehydration with tetracaine 0.25% solution is an easy, safe, inexpensive, and effective analgesia method for nasal packing removal in septoplasty.

The Effect of an Expandable Polyvinyl Acetate (Merocel) Pack on the Healing of the Nasal Mucosa of Sheep

There is a lack of knowledge about the healing of the nasal respiratory mucosa after endoscopic sinus surgery (ESS). Nasal packs often are placed after ESS in an attempt to improve hemostasis and reduce adhesion formation. Most nasal packs need to be removed in the postoperative period. This is uncomfortable for the patient and the affect of these packs on the healing process is unknown. We have standardized the sheep as a suitable animal model to examine the healing of the nasal epithelium after ESS. The nasal mucosa of sheep was wounded under endoscopic guidance and either packed with expandable polyvinyl acetate-based pack (Merocel), which was removed at the 5th postoperative day, or left unpacked to serve as control. Serial biopsies of the wounded area were taken every 28 days, up to 112 days postwounding, for examination using light and scanning electron microscopy. There was no significant difference in the rate of reepithelialization between the packed and control sides of the sheep (p > 0.05). There was no significant difference in the total amount of surface cilia coverage between the packed and control sides at any time points (p > 0.05). There was no significant difference in the maturity of the cilia between the packed and control sides at any time points (p > 0.05). The use of Merocel packing postoperatively neither impairs nor promotes wound healing in the postoperative period.

One-stage nasal and multi-level pharyngeal surgery for obstructive sleep apnoea: safety and efficacy

A collapsible airway is often the common denominator in sleep-disordered breathing (SDB). The upper respiratory tract includes the nasal passage, nasopharynx, oral cavity, oropharynx, base-of-tongue region and the hypopharynx. It is believed that the highest amount of resistance in the upper respiratory tract is in the nasal cavities, and particularly the nasal valve. Most authors believe that when considering surgical options for patients with obstructive sleep apnoea (OSA) it is imperative to correct nasal pathology together with the other sites of airway obstruction. In this retrospective study, I sought to investigate the safety and efficacy of one-stage nasal and multi-level pharyngeal surgery. I compared two groups of patients: group 1, receiving one-stage nasal and multi-level pharyngeal surgery; and group 2, receiving only multi-level pharyngeal surgery. In group 1, nine out of 12 patients (75 per cent) met the criteria for surgical success, with a mean pre-operative apnoea-hypopnoea index (AHI) decreasing from 36.3 to 8.9 post-operatively (p<0.0002), while in group 2, 25 out of 40 patients met the surgical success criteria (62.5 per cent), with their mean AHI decreasing from 52.6 to 10.2 (p<0.0000). When comparing the surgical success rates between the two groups, it was not statistically significant, at p>0.106. There were no postoperative respiratory-related complications despite having bilateral nasal Merocel (tampon) packing in place (in group 1), and none of the patients in either group had any desaturation, hypoxaemia, apnoea or OSA-related complications. This series suggests that, with adequate post-operative monitoring, it is both safe and efficacious to perform both nasal and multi-level pharyngeal surgery in the one surgical session.

A prospective double-blind randomized controlled trial of the effect of topical bupivacaine on post-operative pain in bilateral nasal surgery with bilateral nasal packs inserted

To ascertain whether local anaesthetic use is of clinical benefit in nasal surgery, a prospective double-blind randomized controlled trial of topical bupivacaine on post-operative pain in patients packed after bilateral nasal surgery was carried out. Each patient received a bupivacaine-soaked and a saline-soaked Merocel pack, thereby acting as their own control. Power analysis ascertained the number of patients required to enter the trial to detect a statistically significant difference in pain. Fifty-seven patients completed the trial. Visual analogue scales determined the level of post-operative pain at different time points in each nostril. Less pain was demonstrated in nostrils containing bupivacaine-soaked packs compared with saline-soaked packs at two hours (p < 0.0001), four hours (p = 0.0183) and six hours (p = 0.0476) post-operatively. Although not statistically significant, less pain was noted on pack removal on the local anaesthetic sides. These results provide clinical-based evidence for the use of bupivacaine as a local anaesthetic in reducing pain following nasal surgery with packing.

Endoscopic transnasal approach for the treatment of medial orbital blow-out fracture: a technique for controlling the fractured wall with a balloon catheter and Merocel.

The authors repaired a medial blow-out fracture by using an endoscopic transnasal technique with a balloon catheter and Merocel packing in 17 subjects. The follow-up periods were from 6 weeks to 2 years, and averaged 6 months. The length of the operation was 50 minutes on average. The enophthalmos was corrected in seven of the eight patients. Supporting material for the fractured medial orbital wall was kept in place for 1 to 3 weeks. The mean volume of balloon inflation was 2 cc. The result was satisfactory. No complications resulted from the transnasal endoscopic technique. This endoscopic transnasal approach allows for a better aesthetic result because it eliminates external scarring and permits a direct approach to the medial orbital wall and has a superior visualization. A balloon catheter was used to support the fractured medial orbital fracture, which was adapted, ballooned, and then visualized using a radiopaque dye (Visipaque) in 11 cases. A postoperative computed tomographic scan revealed that this is a very useful method for controlling the status of the reduced orbital wall and eliminates the possibility of complications resulting from infection. A resected uncinate process was used as a bone graft material to repair the large defect in five cases. This method provides several advantages including a mucoperiosteal attached bone graft, working in the same operative field, and cost-effective surgical time. A transnasal endoscopic technique for medial orbital fracture is also very useful for releasing entrapment of the medial rectus muscle, because it directly pushes against the fractured wall and gives good exposure of the medial orbital wall.

Epistaxis strategy--experiences with the last 360 hospitalizations

The purpose of this study was to analyze the therapy concept used in the management of severe epistaxis in order to optimize the quality of our treatment and to arrive at an optimal therapeutic concept. The study was performed as a retrospective analysis of the charts of all 335 patients treated as inpatients for epistaxis over a period of 6 years. An increased rate of complications was found in the following three situations: 1. Age > 65 years, 2. chronic obstructive pulmonary disease, 3. several systemic illnesses. Recurrence was increased with septal perforations and Osler's disease. Localization of the site of bleeding is the first priority and allows treatment of bleeding with bipolar electrocautery. If the bleeding vessel is not found, insertion of a Merocel pack is recommended. Patients with persistent or recurrent bleeding are treated in the operating theater under general anesthesia if they are at an elevated risk for complications or have a septal deviation which is clinically significant. The nose is systematically visualized with the endoscope, bleeding vessels are coagulated under endoscopic control, and, where appropriate, a septoplasty is performed. In the remaining cases an epipharynx balloon is inserted, combined with an anterior pack. Angiography with superselective embolization, external ligation of the ethmoidal arteries, and endonasal obliteration of the sphenopalatine artery is reserved for cases where the measures discussed above have failed.

The use of Merocel nasal packs in the treatment of epistaxis.

Over the period of a year, Merocel nasal packs were used routinely as the primary form of packing in patients referred to the hospital with epistaxis that had not resolved with simple measures, and in whom packing was thought to be required. Their effectiveness was assessed. The packing was usually performed by inexperienced senior house officers. The Merocel packs successfully controlled bleeding in 91.5 per cent of the patients in whom they were used. Use of the correct insertion technique is very important but is very easy to learn and perform. The actual insertion takes only a couple of seconds. Discomfort during insertion, whilst in situ and on removal was assessed. Merocel nasal packing is an effective form of first line treatment in patients with epistaxis.

An evaluation of merocel and neosporin impregnated ribbon gauze packs in patients following nasal surgery: a prospective randomised trial

Background: Packs are placed following nasal surgeries to arrest haemorrhage, to prevent septal haematoma and synechie formation. Despite Merocel, a tampon constructed from a foam polymer of hydroxylated polyvinyl acetate, which is less abrasive and hence associated with the less pain, we still use Neosporine Impregnated Ribbon Gauze (NIRG). Objective: To compare Merocel and the Neosporine Impregnated Ribbon gauze (NIRG) packs in regards to the post-operative pain levels caused by them and their ability to prevent haemorrhage, crusting and synechie. Methods: The nose was packed after surgery either with the Merocel pack or Neosporin Impregnated Ribbon Gauze (NIRG) according to the randomisation. The pain score was noted on the Visual analog score while packs were in situ and again immediately after the pack removal. The haemorrhage, crusting and synechie were noted if present. Results: Among 106 patients, 61 were male and 45 were female. In Merocel group there were 51 patients and in NIRG group 55. The mean pain score for merocel was 4.15 while in situ and 3.66 immediately after removal where as mean pain score for NIRG was 6 while in situ and 3.78 immediately after removals. Post-operative crusting and synechie were seen relatively more in NIRG pack group. Conclusion: Merocel is superior in terms of both patient comfort and pain. DOI: http://dx.doi.org/10.3126/hren.v10i1.6004 HREN 2012; 10(1): 30-34