Abstract

Nasal bleeding is extremely common and affects all age group.5 to 10% of population experiences every year.  Most of the epistaxis ceases spontaneously and only a few would require nasal packing. Nasal Packs had been used routinely for refractory epistaxis. Conventional gauze pack and Merocel nasal pack are the common pack used in refractory anterior epistaxis.

Aim: To study the effectiveness of conventional nasal pack with merocel nasal pack in terms of discomfort experienced by the patient during pack insertion and pack removal, blood pressure changes, need for repacking after removal of pack and nasal mucosal injury.

Methods: Study is based on analysis of 32 patients who had severe epistaxis which was refractory to digital pressure and medical management in the period from October 2017 to October 2019 at Rajah Muthiah Medical College, Chidambaram.32 patients were divided into group A and group B containing 16 patients in each group. Group A was packed with conventional gauze pack soaked in Vaseline or Bismuth Iodoform Paraffin Paste. Group B was packed with Merocel Nasal Tampon pack.

Results: The mean discomfort score during pack insertion using visual analog score was higher 7.1 with group A than 3.5 with group B. Similarly, the mean discomfort score during pack removal was more with conventional nasal gauze (3.75) than merocel nasal pack (1.25). Blood Pressure was found to be increased after pack insertion with 12 mmhg in group A and 4mm Hg in group B.  However, it was not statistically significant. Incidence of repacking was more with merocel pack. 1 patient required repacking in conventional nasal pack and three patient with merocel pack. The mean mucosal scoring was more with conventional nasal pack than merocel which was statistically significant on day 1. There was no significant mucosal injury between 2 group on day 7 and 14. 

Conclusion: Merocel nasal pack is a favourable technique in view of ease of insertion, lesser insertion time and short learning curve. However, Conventional nasal pack is the time tested technique with less incidence of repacking, hence more acceptable to the patient.

Keywords: Conventional gauze pack,  Merocal Nasal Tampon pack, Epistaxis.