Packing Of Groups Research Articles

To pack or not to pack- A Randomized Clinical Trial comparing the Immediate Outcomes of Packed and Non Packed abscess wounds

Introduction: The objective of this study was to determine if there was any benefit from routine abscess packing after incision and drainage as compared to incision and drainage alone, as there seems to be emerging literature negating this practice.
 Methods: A prospective randomized study incorporating abscess from different locations of the body, measuring less than 7 cm, were taken. Incision and drainage was carried out under local or general anesthesia after routine preparation by the surgical resident under guidance of the surgical registrar. The subjects were then randomized into abscess cavity packing and non-packing groups with prescription for antibiotics, analgesics and narcotic analgesics. The subjects were followed up in surgical outpatient by the same resident, where the wound was examined, pain was noted for the duration using the VAS and number of narcotic analgesics taken were noted.
 Results: Total of 92 patients was included divided equally in both groups. There was equality within the two groups regarding age, sex and location of abscess. The primary outcome, which was to find out the need for intervention in the first 48 hours after the procedure was compared and there was no significant difference in the interventions needed in the first 48 hours between the two groups (p= 0.49, difference in means =.536, 95% CI = -2.14 to 1.07). There was no difference in the overall pain perceived by the patients of the two groups, as the total patients who experienced pain were 77, of which 41(53.2%) were in the wound packed group and 36 (46.8%) non-packed group, (difference in means = 0.783, 95% CI= 0.40 to 1.16, p=0.75), but of the 19 patients who experienced severe pain, 15 were from the packed group and 4 were from the non-packed group (p = 0.02). 29 patients from the packed group required narcotic analgesics whereas only 12 from the non-packed group required them (p=0.009, 95% CI= 0.20 to 0.58).
 Conclusion: Packing of the abscess cavity does not carry any added benefit as compared to Incision and Drainage alone and it causes more severe pain and discomfort to the patient with increased analgesic requirements.

A study evaluating the effects of throat packs during nasal surgery: a randomised controlled trial.

The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.

Effect of Fibrin Glue Injection Into the Cavernous Sinus for Hemostasis During Transcavernous Surgery on the Cerebral Venous Draining System.

The extradural temporopolar transcavernous approach can be used to treat central skull base pathologies, but control of bleeding from the opened cavernous sinus is essential. Oxidized cellulose cotton packing and fibrin glue injection can be used, but the effect on the postoperative venous draining pattern remains unclear. To investigate changes in the venous drainage pattern immediately after transcavernous surgery with and without fibrin glue injection into the bleeding cavernous sinus. A total of 82 patients treated via the transcavernous approach were retrospectively divided into 2 groups based on the hemostasis methods. Both pre- and postoperative angiography and/or 3-dimensional computed tomography venography were available for 24 patients in the cotton packing group and 12 patients in the fibrin glue group. Postoperative change in the venous draining pattern was observed in 5 of the 24 patients in the cotton packing group and in 3 of the 12 patients in the fibrin glue group. One of the 82 patients showed postoperative brain swelling due to obstruction of the sphenoparietal sinus. The volume of injected fibrin glue ranged from 0.5 to 2.5mL (mean, 1.1 ± 0.5mL), but none of the patients had brain swelling. Direct fibrin glue injection into the opened cavernous sinus is relatively safe, but a change in the venous draining pattern occurs in 25% of patients. The study indicates the potential danger of the change in the venous draining pattern and recommends limiting the injection volume of fibrin glue in transcavernous surgery to avoid complications related to venous congestion.

A comparative study between nasal clips and anterior nasal packing in septoplasty/submucosal resection patients at VIMS Bellary, Karnataka

<p class="abstract"><strong>Background:</strong> Nasal packing is used primarily to control bleeding, for internal stabilization and to prevent postoperative complications in endonasal surgeries. Nasal septal clip is one of the alternatives, whose effectiveness in surgical practice is less studied upon.<strong> </strong>To compare the effectiveness between nasal septal clip and anterior nasal packing following septoplasty/submucous resection.</p><p class="abstract"><strong>Methods:</strong> Prospective Randomised Controlled Study was conducted in Department of Otolaryngology at Vijayanagara Institution of Medical Sciences, Bellary, between November 2014 to May 2016. Study involved 100 patients fulfilling inclusion and exclusion criteria. Adopting sealed envelope technique, patients were allotted into two equal groups for anterior nasal pack and nasal septal clip following septoplasty or submucosal resection. Interventions were done following standard procedures and data was collected by using pre-tested proforma. </p><p class="abstract"><strong>Results:</strong> Mean age of anterior nasal pack group and nasal septal clip group was 27.86 and 25.24 years respectively. Intra-operatively, packing with nasal septal clip was easier with significantly less trauma to mucous membrane (X<sup>2</sup>= 6.353, P= 0.011), consuming significantly less time (t= 9.329, P<0.0001) and support provided to septum could be assessed visually when compared to anterior nasal packing. During immediate post-operative period and while pack removal, nasal septal clip had significantly less complications (P < 0.001). Follow-up complications like septal haematoma, synaechiae & septal perforations were lesser in nasal septal clip group</p><p><strong>Conclusions:</strong> During intra-operative period, immediate post-operative period, during nasal pack removal and during follow-up period nasal septal clip provided technical superiority, smooth post-operative experience and lesser complications compared to anterior nasal packing proving nasal septal clip to be a better choice for nasal packing. Limitations of NSC are its availability and cost. </p>

The effects of Gua sha on symptoms and inflammatory biomarkers associated with chronic low back pain: A randomized active-controlled crossover pilot study in elderly

ObjectiveTo address the challenges for trialing with elderly and the lacking of valid sham/placebo control, a randomized crossover pilot study is designed and its feasibility on elderly subjects is evaluated. DesignA pilot randomized crossover study was conducted with hydrocollator-based hot pack therapy as active control. Pain intensity, physical disability, depression, general health status, and salivary biomarkers were assessed as outcome measures. ResultsDespite there was no significant difference observed between any outcome measures attained by the two interventions, several important differences were noted during the one-week follow-up period. The magnitudes of pain reduction (21–25% versus 16–18%) and disability improvement (45–52% versus 39–42%) were greater in the Gua sha-treated group than the hot pack group. Both treatments were shown to improve flexion, extension and bending movements of the lower back, whereas areas of improvement varied between the two interventions. Decreasing trends were observed in both tumor necrosis factor-alpha (TNF-α) and heme-oxygenase-1 (HO-1) levels following Gua sha. However, rebounds of the biomarkers were observed one week following hot pack. Furthermore, in response to Gua sha, the decrease of TNF-α was strongly correlated with the improvement of physical disability, whereas the physical disability was correlated with the VAS pain intensity. ConclusionIt demonstrated a feasible clinical trial protocol for evaluating the effectiveness of Gua sha and other therapeutic modalities. Gua sha may exhibit a more long-lasting anti-inflammatory effect relative to hot pack for pain relief and improved mobility in elderly patients with chronic low back pain.

Transseptal suturing technique in septoplasty: impact on bacteremia and nosocomial colonization.

Although effects of Merocel® nasal packs and silicone splints on nasal flora alterations and bacteremia formation after septoplasty were assessed before, the effect of transseptal suturing technique has not been studied yet. The objective of this study is to compare nasal flora alterations and bacteremia occurrence rates between Merocel packs, silicone splints, and transseptal suturing technique in septoplasty. Ninety patients were divided into three groups randomly: Merocel packing (Group M), silicone splint (Group S), and transseptal suturing without packing (Group T). Group M and S received prophylactic antibiotics and antibiotic pomade application to packs, whereas neither antibiotic prophylaxis nor topical pomade was applied to Group T. Preoperative, after pack removal and 1month after pack removal nasal swab cultures and preoperative, immediately after surgery and 24h after surgery blood cultures were taken from all patients. Group M increased Methicillin-sensitive Staphylococcus aureus (MSSA) colonization (p = 0.003) and decreased normal flora colonization (p = 0.038), whereas Group S and T did not affect MSSA or normal flora colonization (p > 0.05). Antibiotic prophylaxis did not affect MSSA colonization (p = 0.14), whereas decreased normal flora colonization (p = 0.029). Transseptal suturing did not prevent bacteremia formation. Postoperative increasing of MSSA colonization in nasal cavity for septoplasty patients can be prevented by using transseptal suturing technique or silicone splints instead of Merocel packing, rather than applying prophylactic antibiotic treatment. Using transseptal suturing does not prevent bacteremia formation during septal surgery. These findings should be kept in mind to prevent postoperative life-threatening infective complications of septoplasty especially in immunosuppressive patients and patients with cardiovascular diseases.

SEPTOPLASTY WITH OR WITHOUT POSTOPERATIVE NASAL PACKING: COMPARATIVE STUDY

Background Anterior nasal packing after septoplasty, when performed, it aims at reducing the risks of postoperative bleeding and hematomas formation; however, the demerits of anterior nasal packing motivate the idea of septoplasty without nasal packing. Objective: To assess the value of anterior nasal packing after septoplasty. Type of Study: Randomized clinical trial. Patient and Methods: This study was conducted on 50 patients who underwent septoplasty in one institute by the same surgeon (the senior author). They were randomly divided into two groups, in the first group postoperative anterior nasal pack was performed, in the second group there was no packing. Evaluation of subjective symptoms and physical finding was performed at three stages, early postoperative stage (at first and third day), 7 days, 2 weeks, and 2 months after surgery. Results: In the early postoperative stage, the first group experienced less feeling of pain, 2 cases in the second group experienced severe nasal bleeding that requires overnight admission and the bleeding was controlled without packing; also, sensation of pain, lacrimation, swallowing difficulties, and sleep disturbance were significantly higher in the first group in this stage. At the 7th day, the 2nd week, and the 2nd month after surgery, the prevalence of granulations, infection, and crust formations, respectively, were significantly higher in the packing group. Conclusion: Septoplasty without postoperative anterior nasal pack is more compliant with less postoperative morbidities. Packing should be preserved for patients with excessive bleeding during the primary surgery. Keywords: internal nasal packing; nasal septum; quality of life

A comparison of the effects of epinephrine and xylometazoline in decreasing nasal bleeding during nasotracheal intubation.

BackgroundVarious techniques have been introduced to decrease complications during nasotracheal intubation. A common practice is to use nasal packing with a cotton stick and 0.01% epinephrine jelly. However, this procedure can be painful to patients and can damage the nasal mucosa. Xylometazoline spray can induce effective vasoconstriction of the nasal mucosa without direct nasal trauma. In this study, we aimed to compare the efficacy of these two methods.MethodsPatients were randomly allocated into two groups (n = 40 each): xylometazoline spray group or epinephrine packing group. After the induction of general anesthesia, patients allocated to the xylometazoline spray group were treated with xylometazoline spray to induce nasal cavity mucosa vasoconstriction, and the epinephrine packing group was treated with nasal packing with two cotton sticks and 0.01% epinephrine jelly. The number of attempts to insert the endotracheal tube into the nasopharynx, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. An anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5 min after intubation and postoperative complications.ResultsNo significant intergroup difference was observed in navigability (P = 0.465). The xylometazoline spray group showed significantly less epistaxis during intubation (P = 0.02). However, no differences were observed in epistaxis 5 min after intubation or postoperative epistaxis (P = 0.201). No inter-group differences were observed in complications related to nasal intubation and nasal pain.ConclusionXylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.

Effects of kinesio taping and hot packs on premenstrual syndrome in females.

[Purpose] This study aimed to evaluate the effects of taping and hot packs on premenstrual syndrome, in an attempt to generate basic data for physical therapy intervention for premenstrual syndrome. [Subjects and Methods] Thirty-two females in their 20s with premenstrual syndrome were randomly assigned to a taping group (n=10), hot pack group (n=11), and taping with hot pack group (n=11). Premenstrual syndrome was assessed using the Menstrual Distress Questionnaire in each participant prior to intervention and was re-assessed after applying kinesio taping and/or hot pack from 10 days before the estimated date of menstruation until the first day of menstruation. [Results] Data revealed that the taping and taping with hot pack groups showed significantly reduced premenstrual syndrome following intervention. In terms of the differences in the Menstrual Distress Questionnaire total score among the groups, the taping with hot pack and hot pack groups showed a significant difference. [Conclusion] These findings indicate that kinesio taping is an easy, non-drug intervention for female college students with premenstrual syndrome.

Conservative Hepatic Hydatid Cyst Surgery

The principal objectives to be achieved by surgical treatment are total removal of all parasitic elements, avoidance of spillage of contents of the cyst and management of the residual pericyst cavity. Thirty four patients with thirty five hepatic hydatid disease were included in the study. The data for this work were collected between 9-2015 till 9 -2016. The mean age were 38.6+13.2 years. There were twenty female and fourteen males. The main presentation was upper abdominal mass, 25 (73.5%) were in the right lobe, 8 (23.5%) were in the left lobe and only one (3%) was bilaterally presented. Conservative surgery in the form of cystotomy (with or without omental packing), and external drainage were applied to 32 cysts (91.4%) while radical surgery were applied to three cysts (8.6%) in the form of pericystectomy and partial hepatectomy. LOS in the conservative group was 6.3+2.5 day while in the radical group was 13.3+8.3 day (P<0.001 HS). There were two cases of post operative bile leak in the omental pack group (22.2%) and only one case (33.3%) among the three cases of external drainage group, so in the conservative surgery there were three cases (9.3%) and they resolved spontaneously. There were two redo one in the cystotomy patients, the other in the pericystectomy patients. Conclusion: Conservative surgery could be done with success in hepatic hydatid disease and resection procedures are too radical and extensive for benign lesions.

Nasal Septal Chain Suture: A New Suturing Technique.

As a new technique for suturing the nasal septum, the nasal septal chain suture has been described in this study, and compared with nasal packing and the quilting suture technique in terms of patient comfort after septoplasty. A total of 75 patients were evaluated in 3 groups: Merocel nasal packing group, absorbable quilting suture group, and nonabsorbable nasal septal chain suture group. The symptoms of these patients were evaluated using the nasal obstruction symptom evaluation (NOSE) scale and rhinomanometry measurements. The NOSE scale values were significantly higher on the postoperative 1st and 3rd days in the nasal packing group (P < 0.001 and P < 0.001, respectively). The nasal resistance was significantly lower (P = 0.011) and the nasal airflow significantly higher (P < 0.001) in the suture groups on the postoperative 3rd day. The use of nasal packing was found to shorten the surgery duration significantly (P < 0.001), while there was no difference between the 2 suture groups (P = 1.000). There was significantly severe pain during the removal of the nasal packing when compared to the nasal septal chain suture removal (P < 0.001), but there was no difference in the bleeding (P = 0.460). Overall, nasal septal sutures significantly improve patient comfort during the postoperative period, when compared to nasal packing, with an earlier return to nasal respiration. The nasal septal chain suture that has been described in this study for the first time can be an alternative to nasal packing and the nasal septal suture techniques currently in use, since both absorbable and nonabsorbable materials can be used, it is easy to remove, and there is no pain during the suture removal.

A Randomized Controlled Trial Comparing Packing with Nonpacking of Perianal Abscess Cav

Introduction: Anorectal abscess is a potentially debilitating condition and one of the common anorectal conditions encountered in practice. Anorectal abscesses are defined by the anatomic space in which they develop and are more common in the perianal and ischiorectal spaces. Traditional management of perianal abscess involves early incision, drainage, curettage and packing of the residual cavity. Cavity packing and dressings are problematic in that they cause significant discomfort and require multiple visits to change the packing until healing. An alternative to the traditional approach is to perform adequate incision and drainage and then to allow healing without the use of cavity dressings.&#x0D; Objective: To compare the effects of packing with nonpacking of the perianal abscess cavity on patient discomfort and wound healing and subsidiary evaluation of the clinical outcomes.&#x0D; Materials and Methods: This single centre randomized controlled trial was carried out on 50 patients who were operated upon for perianal abscess in Combined Military Hospital, Dhaka during the period of July 2014 to June 2016. Patients were randomly assigned to receive either packing or nonpacking treatment through allocation by sealed envelope. The packing (control) group was instructed to report to a single nursing staff for subsequent dressing with packing of the residual cavity. The nonpacking group was discharged with a superficial protective dressing; they did not undergo wound dressing but managed their own wounds until follow-up. Outcome measures were time of healing, abscess recurrence, fistula formation and post operative pain.&#x0D; Results: A total of 54 patients were enrolled (4 lost in follow-up): 24 in the packing and 26 in the nonpacking arm. The two groups were comparable in terms of age and gender distribution, type, size of the abscess, duration of symptoms and length of follow-up. Healing in the non-packing group was faster compared to that of the packing group: mean 24.08 days versus 34.13 days (P=0.000). The rate of abscess recurrence was similar (P=0.664). Post operative fistula rates were similar (P=0.623). Pain scores appeared less in the nonpacking arm and statistically significant (7.25 vs. 4.24, P=0.000).&#x0D; Conclusion: Small size of the study population was the limitation of this study. In order to obtain a higher level of evidence, an adequately powered multicentre based prospective randomized controlled trial is required to definitely address the question of packing of the cavity and its beneficial outcome following incision and drainage in the management of perianal abscess.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 111-116

Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis.

Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method. We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze. Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively. Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia. 1B Laryngoscope, 127:1026-1031, 2017.

SARS-CoV fusion peptides induce membrane surface ordering and curvature

Viral membrane fusion is an orchestrated process triggered by membrane-anchored viral fusion glycoproteins. The S2 subunit of the spike glycoprotein from severe acute respiratory syndrome (SARS) coronavirus (CoV) contains internal domains called fusion peptides (FP) that play essential roles in virus entry. Although membrane fusion has been broadly studied, there are still major gaps in the molecular details of lipid rearrangements in the bilayer during fusion peptide-membrane interactions. Here we employed differential scanning calorimetry (DSC) and electron spin resonance (ESR) to gather information on the membrane fusion mechanism promoted by two putative SARS FPs. DSC data showed the peptides strongly perturb the structural integrity of anionic vesicles and support the hypothesis that the peptides generate opposing curvature stresses on phosphatidylethanolamine membranes. ESR showed that both FPs increase lipid packing and head group ordering as well as reduce the intramembrane water content for anionic membranes. Therefore, bending moment in the bilayer could be generated, promoting negative curvature. The significance of the ordering effect, membrane dehydration, changes in the curvature properties and the possible role of negatively charged phospholipids in helping to overcome the high kinetic barrier involved in the different stages of the SARS-CoV-mediated membrane fusion are discussed.

Influence of moist healing dressing on comfort degree and complications in patients with nasal packing for epistaxis patients

Objective To investigate the moist healing dressing nasal packing for epistaxis patients' physiological comfort and complications. Methods 70 patients of epistaxis patients with nasal packing by drawing lots were divided into A, B two groups of 35 cases. Group A used Vaseline gauze, and group B used moist healing dressings of composite fillings. Comparison of the two groups of pain, nasal odor, sleep disorders, hemostatic effect, nasal mucosa reaction, fever, nasal adhesions were conducted. Results Patients when nasal packing group A pain, sleep disorders and nasal odor scores were (9.80 ± 0.12), (7.10 ± 0.33) and (9.44 ± 0.25) points, group B were (3.82 ± 0.16), (3.22 ± 0.16) and (0.37 ± 0.09) points. Group A scored significantly higher than group B, the difference was statistically significant (t=-179.97, -7.22, -7.33, P <0.05). Group A fever and nasal adhesions were 33 cases and 6 cases respectively, while those figures in group B both were 0, the difference was statistically significant (χ2=62.43, 6.56, P <0.05). Conclusions Nasal packing varying degrees of discomfort in patients, the use of moist healing dressings for epistaxis targeted composite filling, can significantly increase the patients’ physiological comfort and reduce the complications of nasal packing. Key words: Epistaxis; Moist healing dressings; Nasal packing; Comfort; Complications

Internal dressings for healing perianal abscess cavities.

Internal dressings for healing perianal abscess cavities.

The Effects of Nasal Packing and Transseptal Suturing After Septoplasty on Olfactory Function, Patient Comfort, and Mucociliary Clearance.

This study compared the effects of nasal packing and transseptal suturing after septoplasty by evaluating olfactory function, pain, and mucociliary clearance. The study enrolled 39 patients diagnosed with isolated septal deviation. The patients were randomly assigned to 2 groups. In Group A (n = 21), transseptal sutures were placed for septal stabilization after the septoplasty. In Group B (n = 18), both nasal passages were packed with Merocel tampons after the septoplasty. It was made Sniffin Sticks test, sacchranirine test, and pain and discomfort scales preoperatively, 1 week postoperatively and 3 months postoperatively on all patients. There was no postoperative bleeding, submucoperichondrial haematoma, or abscess formation in either group. The postoperative discomfort and pain scores were increased in Group B (the packing group) in our study, the mucociliary clearance improved after septoplasty in both groups, and there was no significant difference in mucociliary clearance between the 2 groups. The odor threshold, odor identification, and odor discrimination were significantly increased 3 months postoperatively, but not 1 week postoperatively. Nasal packing causes more discomfort and pain than transseptal suturing, while there was no significant difference in olfactory functions or the mucociliary clearance after septoplasty between nasal packing and transseptal suturing.

The effects of a cold pack on postoperative turbinate and/or septal bleeding and pain.

The objective of this study is to evaluate the effects of a cold pack in postoperative turbinate and/or septal surgery in terms of postoperative bleeding control, pain management, and patient preference for or against application of a cold pack. A randomized controlled trial was done at the Department of Otolaryngology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Ninety-nine adult subjects intending to have turbinate and/or septal surgery were consecutively enrolled in this study. Intervention was randomized into two groups. Postoperative bleeding was collected by paper tissue and weighed to determine amount and/or volume of blood loss. Postoperative pain was measured by using the visual analog scale. Patient preference for or against the use of a cold pack was also assessed. The mean (standard deviation) postoperative bleeding in the cold pack group was 1.31 ± 1.50 g compared with 1.81 ± 1.89 g in the control group. The mean difference was 0.50 g (95% confidence interval, -0.19 to 1.19 g; p = 0.15). The mean (standard deviation) postoperative visual analog scale pain score in the cold pack group was 2.40 ± 2.32 compared with 3.33 ± 2.83 in the control group. The mean difference was 0.94 (95% confidence interval, -0.11 to 1.99; p = 0.79). Most of the subjects preferred using a cold pack (78.7%) to not using a cold pack (21.3%) (p < 0.001). A cold pack after turbinate and/or septal surgery had no benefit in terms of postoperative bleeding or postoperative pain.

Efficacy and safety of pelvic packing after emergency peripartum hysterectomy (EPH) in postpartum hemorrhage (PPH) setting

ObjectivesTo study the safety and effectiveness of pelvic packing in the control of post emergency peripartum hysterectomy (EPH) bleeding in a postpartum hemorrhage (PPH) setting. Study designFrom 39 patients with a severe PPH leading to an EPH (January 2010–December 2013), we identified a group of 17 patients requiring a pelvic packing (packing group) and a second group of 22 patients not requiring a pelvic packing (non-packing group). For each group, transfusion requirements were recorded from time of PPH diagnosis to end of the surgical procedure (P1: Period 1) and from that point to the end management in the SICU (P2: Period 2). Laboratory values, transfusion requirements and complications were compared between the 2 groups. Statistical comparisons were performed using Mann–Whitney test, Fisher's exact test and chi-square test. A p-value <0.05 was considered statistically significant. ResultsPelvic packing was successful in the control of bleeding in all the cases. During the second laparotomy for pack removal, none of the patients developed complications such as bowel injuries or necrosis. The 2 groups were similar in term of laboratory values at the end of the surgical procedure and 24h after the end of the surgical procedure. The number of PRBC units required in P1 was higher in the packing group compared to the non-packing group (16.6±5.3 vs 14±5; p=0.04), however the decrease in the amount of PRBCs transfused between P1 and P2 was higher in the packing group (13.3) compared to the non-packing group (9.1) (p<0.01). The incidence of febrile morbidity was higher in the packing group compared to the non-packing group (53% vs 9%; p=0.04); but no significant difference was shown in term of generalized sepsis, as well as renal failure, ARDS, deep vein thrombosis, pulmonary embolism and MOF. ConclusionThe pelvic packing is a valuable method with a high success rate in the control of hemorrhage after an EPH in PPH setting with a low rate of complications. It is quite simple and quick to perform, and therefore should be kept in mind by all obstetricians as a lifesaving technique.

Effect of local cold and hot pack on the bruising of enoxaparin sodium injection site: a randomized controlled trial

Purpose: This study aimed to assess the effect of the application of local cold and cold-hot packs upon the size of bruising at the injection site of subcutaneous enoxaparin sodium.Methods: One-hundred and eighty patients with coronary diseases were allocated randomly to three groups: (i) local cold gel pack group; (ii) local cold-hot gel pack group; and (iii) control group. Assessment of the presence of a bruise was conducted at 24, 48 and 72 hours after the injections for all patients.Results: The cold-hot pack group had significantly less and smaller injection site bruising than the two other groups at 48 and 72 hours (both p < 0.001).Conclusions: The local application of cold-hot packs is more effective on reducing bruises following enoxaparin sodium injections when compared with local cold pack application alone.Thus, this process can improve the quality of nursing care for hospitalized patients receivingthese injections.