Pack Removal Research Articles

Rigidity‐Driven Structural Isomers in the NaCl–Ga2S3 System: Implications for Energy Storage

Alternative energy sources require the search for innovative materials with promising functionalities. Systems with unusual chemical properties represent an insufficiently explored domain, concealing unexpected features. Using diffraction and Raman spectroscopy over a wide temperature range, supported by first‐principles simulations, a rare phenomenon is unveiled: phase‐dependent chemical interactions between binary components in the NaCl–Ga2S3 system. In this unique occurrence, previously intact binary crystalline species transform upon melting into mixed liquid structural isomers, forming bonds with new partners. The chemical combinatorics appears to be fully reversible for stable crystals and liquids. Despite this, rapidly frozen glasses out of thermodynamic equilibrium remain in a metastable isomeric state, offering remarkable properties, particularly a high room‐temperature Na+ conductivity, comparable to the best sodium halide superionic conductors and therefore encouraging for sodium solid‐state batteries and energy applications. A rigidity paradigm is responsible for the observed phenomenon, as the extremely constrained Ga2S3 crystal lattice does not survive viscous flow, breaking up at a short‐range level. The removal of rigidity constraints and dense packing leads to a significant increase in empty space, which is the origin of high sodium diffusivity. Broadly, the rigidity‐driven structural isomerism opens up an inspiring path to the discovery of atypical materials.

Postoperative management following endoscopic skull base surgery.

The purpose of this opinion is to review current evidence regarding postoperative management following endoscopic skull base surgery. Postoperative management encompasses consideration of level of care, laboratory tests, analgetic and antiemetic therapy, antibiotic, antithrombotic and antiepileptic prophylaxis, pharmacological and nonpharmacological cerebrospinal fluid (CSF) pressure reduction measures, including CSF diversion, activity restrictions, nasal packing removal, nasal debridement and toilet, nasal glucocorticoid administration, positive pressure ventilation, imaging, CSF leak diagnosis, and future perspectives. Although significant effort has been put into research of postoperative measures after endoscopic skull-base surgery, there is a heterogeneity of practices and deficit of high-level studies, which would enable highly powered systematic reviews and meta-analyses.

Do We Need a Relaparotomy to Remove the Perihepatic Packs Used to Control Bleeding? Case Series

Introduction: Liver injuries, often resulting from trauma, present a significant challenge in surgical management. Perihepatic packing has emerged as a critical technique in controlling bleeding and stabilising patients with severe liver injuries. This study aims to evaluate the outcomes of perihepatic packing and removing packs without relaparotomy in a cohort of eleven patients treated over two years.Methods: We conducted a retrospective study of 11 patients with liver injuries identified at laparotomy at General Hospital Kuliyapitiya from May 2020 to June 2022. Excluded were patients who managed without packing. Data were collected from operating theatre records and medical charts, including age, sex, injury mechanism, vital signs, FAST scan results, intraoperative findings, estimated blood loss, blood transfused in the first 24 hours, associated injuries, liver complications, time to pack removal, and incidence of rebleeding.Perihepatic packing has been used for persistent hepatic haemorrhage post-suturing, unsaturable injuries, and hemodynamically unstable patients. Packs have been brought outside the abdomen through a separate incision and sutured to each other if multiple packs were used. A G28 intercostal tube has placed for drainage. Packs have been removed between 48 and 72 hours. The drain has kept for more than 48 hours post-removal to monitor rebleeding. In cases of uncontrollable haemorrhage during pack removal, plans included reopening and repacking if necessary.Results: The study included eleven patients aged 24 to 74 years, with three female patients. The causes of liver injuries were identified as follows: road traffic accidents (63.6%), assault (18.2%), stab injuries (9.1%), and falls from height (9.1%). Pre-operative ultrasound correctly identified liver injuries in 54.6% of patients. Intraoperative findings showed right liver lobe involvement in 63.6% of cases, bilobar involvement in 27.3%, and left lobe involvement in 9.1%. Additionally, 63.6% of patients had other organ injuries. The timing of pack removal was within 48 hours for seven patients (63.6%) and within 48-72 hours for the remaining patients. Drains were removed on the fifth day in 54.50% of patients and on the sixth day in the rest. There were no cases of rebleeding and post of complications were able to be managed conservatively. There was one death with sepsis and multi organ disfunction.Conclusion: Perihepatic packing is a valuable technique in the management of liver injuries, demonstrating high efficacy in controlling haemorrhage and low complication rates. Removal of the pack through the pre-placed incision avoids the relaparotomy and thereby reduces the second trauma to the patient. Further studies with larger cohorts are recommended to validate these findings.

Merocel versus a new septal clip with splint in post septal surgery cases: a prospective study

Septoplasty is one of the most frequently performed surgical procedures in otorhinolaryngology to overcome nasal obstruction. Following septal surgery, nasal packs are commonly inserted by surgeons to support and appose septal flaps the types of which depend on the preference and experience of the surgeon.Background We conducted a study to compare the Merocel sponge with that of a newly developed septal clip with the splint in patients who underwent septoplasty or submucosal resection to find out which one is better. A total of 50 patients were included in the study over a period of 3 years. Patients were divided into 2 groups of 25 each where group M is for patients receiving Merocel after surgery and group C is for patients receiving septal clips with splints.Aim The aim of this study was to assess and compare the effects of a Merocel pack on nasal functions with that of the septal clip and their eventual complications and outcome in the post-operative period.Results The main observations that were found in both groups in the immediate postoperative period were (1) pain (2) nasal obstruction (3) sleep disturbance (4) headache (5) epiphora (6) dryness of mouth and (7) postnasal drip. Pain was mild to moderate in the case of group M (MPS was 2.4) and moderate to severe degree in the case of group C (MPS was 5.7).Nasal obstruction was more common in Merocel group patients. Sleep disturbance, headache, epiphora, post-nasal drip, and dryness of mouth were also more in the Merocel group. After pack removal in both groups, the nasal examination was done to see crusts, vestibulitis, and septal ulcers. All these findings were more in the septal clip with the splint group.Conclusions It was observed that Merocel nasal packing causes significant morbidity and discomfort in the immediate post-operative period as compared to septal clips. It is also expensive. The new septal clips with splints can be used as an effective alternative to Merocel for approximation of flaps after septal surgery.

Case Report: "Navigating the Narrow Path: Unveiling a Nasal Septal Abscess in a Neonate".

Nasal septal abscess in a newborn is a rare condition. This case report describes a case of nontraumatic, nasal septal abscess in a newborn baby with no evidence of sinusitis or other localized trauma/ infections. A 15-day-old newborn was admitted to a tertiary care hospital with a history of nasal blockage and swelling of the nasal septum. Physical examination revealed a fusiform swelling involving the nasal septum. The patient underwent Diagnostic Nasal Endoscopy with Incision and Drainage followed by 48-hour nasal packing. Neonates being obligate nasal breathers, after drainage, due to the bilateral nasal packs, the otolaryngology and paediatric team had to find a way to make the neonate breathe and swallow simultaneously. The neonate showed gradual improvement following nasal pack removal and had a normal nasal airway on follow-up at 14 days and one-month post-drainage. Even though the septal abscess in neonates is a rare entity however, it can significantly compromise the nasal airway in an obligatory nasal breather, and with limited space for intervention also poses a challenge in managing the condition.

Factors Associated With Pelvic Infection After Pre-Peritoneal Pelvic Packing for Hemodynamically Unstable Pelvic Fractures.

Background: Preperitoneal pelvic packing (PPP) and external fixation has led to improved mortality after devastating pelvic trauma. However, there is limited literature on infection after this intervention. We aim to study the risk factors associated with pelvic infection after PPP. Patients and Methods: A retrospective review of patients who underwent PPP at a single level 1 trauma center was performed. Results: Over the 18-year study period, 222 patients were identified. Twenty-three percent of patients had an open fracture. Pelvic angiography was performed in 24% of patients with 16% requiring angioembolization (AE). The average time to packing removal was two (one to two days) days, although 10% of patients had their pelvis re-packed. Overall infection rate was 14% (n = 31); if pelvic re-packing was performed, the infection rate increased to 45%. Twenty-two of the patients with an infection required additional procedures for their infection, and ultimately hardware removal occurred in eight patients. On univariable analysis, patients with pelvic infections had more open fractures (55% vs. 17%; p < 0.01), underwent AE more frequently (29% vs. 14%; p = 0.04), were more likely to undergo repacking (32% vs. 6%; p < 0.01), and had packing in place for longer (2 [1,2] vs. 2 [2,3]; p = 0.01). On logistic multivariable regression analysis, open fracture (odds ratio [OR], 5.8; 95% confidence interval [CI], 2.4-14.1) and pelvic re-packing (OR, 4.7; 95% CI, 1.2-18.5) were independent risk factors for pelvic infection. Conclusions: Pelvic infection after PPP is a serious complication independently associated with open fracture and re-packing of the pelvis. Re-intervention was required in most patients with infection.

Comparison of Polyvinyl Alcohol Sponge and Gauze Packing for Nasal Fracture Treatment: An Efficacy and Safety Analysis.

Nasal fractures are commonly treated using nasal packing as an internal splint after performing closed reduction. Although gauze and polyvinyl alcohol sponge (PVAS) are both commonly used for packing, few reports have compared their efficacy and safety in nasal fracture treatment. Therefore, in this study, the authors, aimed to retrospectively compare the efficacy and safety of gauze packing in 208 patients and PVAS packing in 225 patients who underwent closed reduction at our hospital. The proportions of patients requiring revision surgery did not differ significantly between the PVAS and gauze groups ( P =0.627). However, in comparison to the gauze group, the PVAS group displayed significantly fewer instances of uncontrolled epistaxis following packing removal, as well as fewer occurrences of dropout and loss of packing ( P =0.023, P =0.007, and P <0.001, respectively). The results of logistic regression analysis adjusted for confounding factors also showed that compared with the gauze group, the PVAS group was significantly less likely to experience packing dropout (odds ratio=0.13; 95% confidence interval, 0.06-0.29, P <0.001) for which younger and older age and allergic rhinitis were independent risk factors. In conclusion, both gauze and PVAS are effective packing materials as internal splints after closed reduction of nasal bone fractures. Specifically, PVAS utilization warrants consideration in pediatric and geriatric populations, individuals with allergic rhinitis, and those at elevated risk of bleeding.

Early Removal of Indwelling Catheter and Vaginal Pack After Vaginal Prolapse Surgery: A Retrospective Cohort Study.

After vaginal pelvic organ prolapse (POP) surgery a vaginal pack and indwelling bladder catheter are inserted to reduce blood loss and bladder overdistension. The ideal timing of removal remains unclear. In this study we compared removal of vaginal pack and indwelling catheter 3 h post-surgery with removal the next day. This retrospective cohort study performed in the Netherlands included patients undergoing POP surgery between 1 January 2019 and 31 December 2020. Patients in whom the vaginal pack and catheter were removed the day after surgery (group A) were compared with patients in which the vaginal pack and catheter were removed 3h post-surgery (group B). Both groups were compared regarding urinary retention and the need for re-intervention owing to active blood loss within 6weeks postoperatively. Baseline characteristics, such as age, type of operation and type of anaesthesia in group A (n = 280) and group B (n = 207) were comparable. No significant differences were found regarding complications such as urinary retention (17.2 versus 23.2%; p = 0.255). The rates of re-intervention because of active blood loss and occurrence of infection were also comparable. Removal of the indwelling catheter and vaginal pack 3h after vaginal POP surgery does not lead to more postoperative complications than removal the 1st day after surgery. Therefore, early removal is a feasible and safe alternative to the standard timing of removal the morning after surgery of women undergoing POP surgery. In the future this could help with introducing same-day discharge.

Seizures Associated with Povidone-Iodine Impregnated Antral Pack in a Child: a Case Report and Review of Literature

This is a case of 11 years-old patient diagnosed of suppurative osteomyelitis of the right maxilla. He had incision and drainage with sequestrectomy under general anaesthesia, and povidone-iodine-impregnated antra pack. About 60 hours after surgery, patient began to have seizures, about 6 episodes on the first night, generalized, tonic-clonic, each lasting about 1 minute with post-ictal vomiting. An initial assessment of meningitis (to rule out cerebral abscess) was made. The seizure episodes which lasted for 3 days began to reduce gradually, and completely subsided 24 hours after the removal of the antra pack. However, when the patient had a CT scan with iodine-based contrast as requested by the paediatric neurologist (to rule out cerebral abscess), the episodes went up significantly again for another 24 hours, after which it began to reduce, till none was recorded 48 hours after contrast administration. Povidone-Iodine (PVI) slowly liberates free iodine to exhibit its broad range of microbicidal activity. However, depending on the amount of iodine absorbed, there is a possibility of iodine toxicity, with different systemic manifestations including seizures, especially in children. The seizure is believed to be a result of disruption in the blood-brain barrier by free iodine from PVI and the iodine-based contrast media. Therefore caution should be taken in using PVI as an antiseptic agent in antra packs or on any mucosa surface, especially in children.&#x0D;

Perihepatic Packing: A Life Saving Procedure in Liver Trauma

Objective: Liver is one of the most common organ injured in Blunt and penetrating abdominal trauma and is the 2nd most common cause of mortality in these patients. The main objective of this study is to analyse the role and success rate of perihepatic packing in liver trauma Materials &amp; Methods: This is a prospective study conducted on 200 patients of Liver trauma admitted in a tertiary care hospital over 2 year period with 3 months postoperative followup. Most of the High Grade liver injuries with uncontrolled venous bleeding were subjected to perihepatic Packing. The patient were shifted to ICU postoperatively and reexplored after 48 hours for pack removal. Results: 30 patients were subjected to Perihepatic packing with success rate of 80% in achieving haemostasis.24 cases were due to blunt while 6 due to penetrating trauma. Commonly seen in younger age group with male dominance. Majority of the injuries were AAST Grade III and IV type. Discussion: In Liver trauma the prime goal is Life Saving by control of Haemorrhage. Various advanced procedures are performed for the same, however it may not be possible to carry out all these in an emergency setting of Haemodynamically unstable patients. In these selected cases, Perihepatic packing is the Gold standard to achieve haemostasis as damage control or Definitive procedure. Conclusion: Perihepatic Packing is a highly recommended procedure in selected cases of High Grade liver injuries mainly for control of venous bleeding. Good postoperative ICU ventilator support under Broad spectrum Antibiotic cover is mandatory to minimize morbidity and mortality associated with the procedure. Keywords: Liver trauma, Perihepatic Packing, Blunt abdominal trauma, Reexploration.

Plus moist HS-W®: a new nasal packing material for the middle meatus in endoscopic sinus surgery

PurposeRemoval of the current calcium alginate packing materials to the middle meatus in endoscopic sinus surgery (ESS) is usually accompanied by discomfort or pain owing to the hard and brittle nature of these materials. Plus moist HS-W® is a new calcium alginate packing material released in 2022 developed to overcome this issue by changing the uronic acid component. We aimed to compare the discomfort/pain during the removal of Plus moist HS-W® with Kaltostat®, as well as their suitability as packing materials in ESS.MethodsKaltostat® and Plus moist HS-W® were used as packing materials in 22 and 21 patients who underwent ESS in 2021 and 2022, respectively. Patients were asked to rate the pain during the packing removal 10 days after ESS using the Numerical Rating Scale (NRS). The ratio of residual packing materials, number of suctions (insertions/extractions of the suction cannula), and time required to remove packing materials were measured. Postoperative complications such as hemorrhage, local infection, lateralization of the middle turbinate, and synechia of the middle meatus were also evaluated.ResultsThe Plus moist HS-W® group exhibited significantly lower NRS pain scores, a lower ratio of residual packing materials, a reduced number of suctions, and a shorter time required to remove the packing. No obvious postoperative complications occurred in both groups except for one suspicious case of a slight infection in the Kaltostat® group.ConclusionCompared with Kaltostat®, Plus moist HS-W®, characterized by better gelatinization than Kaltostat®, benefits patients by minimizing discomfort/pain during removal.Level of evidenceLevel 3.

An Analysis of the VELNEZ Nasal Pack's Acceptability and Safety for Use During Nasal Surgery: A Prospective Study.

The primary function of nasal packs is to modulate the bleeding, prevent adhesions and obstruction, with least discomfort to the subjects without risking secondary infection. However, both packing and removal of the pack is an unpleasant experience, with the latter being extremely painful. Therefore the need of the hour is a dressing which prioritizes subject comfort without compromising other desired nasal pack properties.Twenty subjects were enrolled in this interventional, open label study. The subjects had 10 hospital visits, starting from baseline (Visit 1) to postoperative day 28 (Visit 10), at regular intervals. The proportion of the population with postoperative pain alleviation and bleeding control failure (within 10min) were the main objectives. Within 10min of VELNEZ administration, all 20 participants got their bleeding under control. With VELNEZ, the painful nasal pack removal method was totally avoided because it was biodegradable. No moderate/severe pain, infection and adhesions were reported in any of the subjects, but few subjects reported moderate obstruction until Visit 3 (Discharge Day). In the present study, for participants undergoing nasal surgery, VELNEZ proved to be a secure and reliable nasal pack. Trial Registration: CTRI/2021/09/036437, prospectively registered.

Using Surgicel-wrapped Merocel to reduce pain during the removal of nasal packing

Background Merocel is a commonly used material for nasal packing; nevertheless, the majority of patients experience pain when the nasal packing is removed. Aims/Objectives: This study aims to introduce a novel technique for nasal packing using Surgicel-wrapped Merocel. Material and Methods Patients who underwent septoplasty received either Merocel or Surgicel-wrapped Merocel as nasal packing. Clinical complications related to bleeding and subjective symptoms associated with the packing materials were assessed. Results Between 2018 and 2021, a total of thirty-three patients with a deviated nasal septum underwent septoplasty. Among them, eight patients received Merocel nasal packing, while twenty-five patients were treated with the new nasal packing technique involving Surgicel-wrapped Merocel. We observed a significant reduction in pain during removal in the Surgicel-wrapped Merocel group compared to the Merocel group (p = .008). However, no significant differences were noted in other discomforts related to packing or bleeding after removal between these two groups. Conclusions and Significance: Using Surgicel-wrapped Merocel as nasal packing following septoplasty is an effective method to alleviate pain during removal.

Correlation between contrast leakage period of procedural rupture and clinical outcomes in endovascular coiling for cerebral aneurysms.

Intraprocedural rupture (IPR) is a fatal complication of endovascular coiling for cerebral aneurysms. We hypothesized that contrast leakage period may be related to poor clinical outcomes. This study aimed to retrospectively evaluate the relationship between clinical outcomes and contrast leakage period. Data from patients with cerebral aneurysms treated via endovascular coiling between January 2010 and October 2018 were retrospectively assessed. The enrolled patient's demographic data, the aneurysm related findings, endovascular treatment and IPR related findings, rescue treatment, and clinical outcome were analyzed. In total, 2,859 cerebral aneurysms were treated using endovascular coiling during the study period, with IPR occurring in 18 (0.63 %). IPR occurred during initial frame coiling (n=4), coil packing (n=5), stent deployment (n=7), ballooning (n=1), and microcatheter removal after coiling (n=1). Tear sites included the dome (n=14) and neck (n=4). All IPRs were controlled and treated with coil packing, with or without stenting. Flow arrest of the proximal balloon was not observed. Temporary focal neurological deficits developed in two patients (11.1%). At clinical follow-up, 14 patients were classified as modified Rankin Scale (mRS) 0, three as mRS 2, and one as mRS 4. The mean contrast leakage period of IPR was 11.2 min (range: 1-31 min). Cerebral aneurysms with IPR were divided into late (n=9, mean time: 17.11 min) and early (n=9, mean time: 5.22 min) control groups based on the criteria of 10 min of contrast leakage period. No significant between-group differences regarding clinical outcomes were observed after IPR (p=1). In our series, all patients with IPR were controlled with further coil packing or stenting without proximal balloon occlusion within 31 min of contrast leakage. There was no difference in clinical outcomes when the long contrast leakage period group and short contrast leakage period group were compared.

The Role for Preperitoneal Pelvic Packing in Low-to-Middle-Income Countries: A 16-Year Experience at a Johannesburg Trauma Unit.

Preperitoneal pelvic packing for early pelvic haemorrhage control reduces mortality. Bleeding noted with pelvis fractures is predominantly due to associated venous complex injuries. More studies are advocating for angiography as first-line therapy for haemodynamic instability in pelvic fractures; however, these facilities are not in abundance in middle- and low-income countries. We hypothesized that PPP improves outcomes under these circumstances. Retrospective analysis of data from the patients charts over a period of 16years from 01 January, 2005 to 31 December, 2020. All patients over the age of 18years who presented with haemodynamic instability from a pelvic fracture and required PPP were included. The demographics, physiological parameter in emergency department, blood products transfused, morbidity and mortality were analysed. There were 110 patients identified in the study period who underwent pelvic preperitoneal packing for refractory shock or ongoing bleeding. The majority (75.5%) of patients were men (n = 83). The median age was 38years. The most common mechanism of injury was pedestrian vehicle collision (51%), followed by motor vehicle collisions (27.3%). The median ISS and NISS were 35 and 40, respectively. The median RTS in ED was 4.8(3-6.8). None of our patients rebleed after pack removal and no one needed repacking or adjunct angioembolization in our study group. The in-hospital mortality rate was 43.6% (n = 48) in patients who underwent preperitoneal pelvic packing. The operating room table mortality was 20% (n = 22/110), and the mortality rate of those who survived to ICU transfer was 29.5% (n = 26/88). Pelvic preperitoneal packing has a role in the acute management of haemodynamically abnormal patients with pelvic fractures in our environment. In the absence of immediate angioembolization, preperitoneal packing can be lifesaving.

Incidence, risk factors, management and prevention of severe postoperative epistaxis after endoscopic endonasal transsphenoidal surgery: a single center experience.

Postoperative epistaxis is a very rare but severe complication after endoscopic endonasal transsphenoidal surgery (EETS) that can lead to catastrophic consequences. However, the incidence, risk factors, management and prevention of postoperative epistaxis remain unclear. Consecutive patients with pituitary adenoma (PA), Rathke's cleft cyst, craniopharyngioma, or clival chordoma who received EETS in our department between September 2020 and November 2022 were retrospectively analyzed. The incidence, risk factors, management and prevention of postoperative epistaxis were investigated and analyzed. A total of 557 consecutive patients who received EETS were included in this study. Eight patients (1.4%) (7 PAs and 1 Rathke's cleft cyst) experienced severe postoperative epistaxis. The size of the PAs was 9.6 mm-46.2 mm, with a median size of 22.1 mm. Epistaxis occurred 4 h to 30 days (median 14.5 days) postoperatively. Bleeding was stopped in 3 patients after nasal packing with iodoform gauze. The remaining 5 patients for whom nasal packing was insufficient were all sent to the operating room, and posterior nasal septal artery (PNSA) bleeding was identified and successfully treated with endoscopic bleeding artery electrocauterization under general anesthesia. In the EETS, all 8 patients had downward extension of the septal mucosal incision, in which 6 had intraoperative bleeding of PNSA that were cauterized by bipolar diathermy. Four patients had causative factors, including administration of antiplatelet agents, Valsalva-like manoeuvre, nose blowing and removal of nasal packing, respectively. No patients had recurrent epistaxis during the follow-up period. Post-EETS epistaxis is a rare but severe complication that could lead to catastrophic consequences, and one of the most common bleeding sources is the PNSA. Endoscopic bleeding artery electrocauterization under general anesthesia may be a safe, economic and effective measure for epistaxis refractory to nasal packing. Avoiding excessive downward extension of the septal mucosal incision could contribute to the prevention of postoperative epistaxis.

AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery

ObjectiveAfter Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. MethodsThis retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. ResultsComputed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p=0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p=0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. ConclusionPhysicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. Level of evidenceLevel 3.

Topical Calcium channel blockers for effective post operative analgesia for hemorrhoidectomy patients; A Randomized Control Trial at a Tertiary Care Hospital.

Objective: To compare the mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only. Study Design: Randomized Controlled Trial. Setting: Surgical Department of Holy Family Hospital. Period: 7th January 2022 to 7th July 2022. Material &amp; Methods: Patients fulfilling the inclusion criteria were divided into two groups. Group A patients will receive topical calcium channel blockers whole group B will receive conventional analgesic medications. Patients in both groups underwent open hemorrhoidectomy under saddle block anesthesia. At the end of procedure, a lignocaine gel-soaked pack was placed in rectum which was removed after 6 hours. The post-operative treatment of test group was similar in all regards except that they were given 2% diltiazem ointment to apply to perianal region twice a day. Oral stool softeners were started after NPO duration. The patients were advised to start warm sitz bath and application of 2% lignocaine gel to perianal region 12 hourly after removal of pack. The patients in both groups were compared for the degree of pain on the second post-operative day using visual analogue scale. Results: In this study, on comparison of mean pain scores after hemorrhoidectomy in patients given topical calcium channel blocker and patients being given routine post-operative treatment only shows that pain in Group-A was 5.89+0.80 and in Group-B 3.60+0.77, p value was 0.0001. Conclusion: Topical Calcium Channel Blockers are effective in managing post hemorrhoidectomy pain.

Rhinologist Use of Antibiotics With Nasal Packing for Epistaxis.

There is limited evidence supporting the usage of prophylactic antibiotics in the setting of nasal packing for epistaxis. It is unclear what current antiobiotic usage patterns are by otolaryngologists. Characterize the antibiotic prescribing practices employed by otolaryngologists in the management of epistaxis patients treated with packing as well as the underlying rationale. Explore the impact of experience, geography, and academic affiliation on treatment decisions. An anonymous survey of antibiotic prescribing patterns for patients with epistaxis requiring nasal packing was distributed to all physician members of the American Rhinologic Society. Responses to each question were descriptively summarized including 95% confidence intervals and were linked to demographics using Fisher's exact tests. One thousand one hundred and thirteen surveys were distributed with 307 responses (27.6%). Antibiotic prescription rates varied based on packing type, with 20.0% prescribing antibiotics for dissolvable packing compared to 84.2% to 84.6% for nondissolvable packing. The absorbance of nondissolvable packing does not impact the decision to prescribe antibiotics (P > .999). Precisely 69.7% (95% CI: 64.0%-74.8%) stop antibiotics immediately following packing removal. Precisely 85.6% (95% CI: 81.6%-89.9%) cite the risk of toxic shock syndrome (TSS) when prescribing antibiotics. Notable regional differences include greater utilization of amoxicillin-clavulanate in the Midwest (67.6%) and Northeast (61.4%) as compared with the South (42.1%) and West (45.1%) (P = .013). Further, years in practice were positively associated with several patterns including prescribing antibiotics for patients with dissolvable packing (P = .008), citing prevention of sinusitis as a rationale for antibiotic use (P < .001), and a higher likelihood of having treated a patient with TSS (P = .002). Antibiotic use in patients with epistaxis controlled with nondissolvable packing is common. Treatment patterns are influenced by geography, years in practice, and practice type. 4.

Comparison of outcomes using conventional nasal pack with hydroxylated polyvinyl acetate pack following Septoplasty

Aim: To compare the conventional anterior nasal packing (CANP) with Hydroxylated polyvinyl acetate pack (Merocele) after septoplasty, in terms of pain, bleeding, and postoperative complications like synechia formation. Material and Methods: This study was a prospective, randomized, interventional study conducted among 48 patients. Patients underwent septoplasty under general anesthesia for symptomatic deviated nasal septum. In all the 48 patients, post-surgery, one nasal cavity was packed with a conventional nasal pack and the other cavity was packed with Merocele nasal pack. Pain and bleeding were evaluated during pack removal on the third post-operative day. Synechia was assessed at the 8th post-operative week (2 months) follow-up. The results were compared between the two groups. Result: Out of 48 patients who underwent surgery, 3 patients were lost to follow-up. So, results were compared between 45 patients. Pain and bleeding during removal of conventional and merocele packs were not seen to be statistically significant. Post-operative synechia was not seen in any of the nasal cavities, irrespective of the packing material used. Conclusion: Hence, in terms of pain, bleeding during pack removal, and post-operative synechia; conventional and merocele nasal packs were comparable and there was no significant difference in using either of the materials post-septoplasty.