Thomas D M, Tierney P A, Samuel D, Patel K S
Department of Otorhinolaryngology-Head and Neck Surgery, St Mary's Hospital, London.
Ann R Coll Surg Engl. 1996 Jul;78(4):380-2.
In our department, nasal packs have traditionally remained in place for a period of 24 h after routine elective nasal surgery. We decided to determine whether reducing the duration of nasal packing from 24 h to 2 h would reduce postoperative pain without a concomitant increase in haemorrhagic complications. A series of 72 patients undergoing elective nasal surgery were randomised to have either nasal packs for 24 h (n = 39) or for 2 h (n = 33). Pain was assessed using a visual analogue scale with the nasal packs in place and on their removal. The incidence of haemorrhage was noted. The results showed a significant decrease in mean pain score (MPS) with the packs in place, from 3.4 (range 0.8-6.8) to 1.16 (range 0-2.5); (P < 0.001) and also on pack removal from 5.3 (range 1.2-7.9) to 2.6 (range 0-5.4); (P < 0.05). There was no postoperative haemorrhage in either group. A new standard of 2 h for routine nasal packing was set and our departmental protocols were changed accordingly. Results in a further 36 patients gave a MPS with the packs in place of 1.12 (range 0-3.2) and a MPS of 2.36 (range 0-6.7) on their removal. There was no statistical difference between these and our previous findings. We conclude that postoperative nasal packing for only 2 h rather than 24 h significantly reduces pain without a concomitant risk of haemorrhage.
在我们科室，常规择期鼻科手术后，传统上鼻填塞物会留置24小时。我们决定确定将鼻填塞时间从24小时减至2小时是否能减轻术后疼痛，同时又不会增加出血并发症。72例接受择期鼻科手术的患者被随机分为两组，一组鼻填塞24小时（n = 39），另一组鼻填塞2小时（n = 33）。在鼻填塞物留置期间及取出时，使用视觉模拟评分法评估疼痛程度，并记录出血发生率。结果显示，留置填塞物时平均疼痛评分（MPS）显著降低，从3.4（范围0.8 - 6.8）降至1.16（范围0 - 2.5）；（P < 0.001），取出填塞物时MPS也从5.3（范围1.2 - 7.9）降至2.6（范围0 - 5.4）；（P < 0.05）。两组均未发生术后出血。我们设定了2小时的常规鼻填塞新标准，并相应地更改了科室规程。另外36例患者的结果显示，留置填塞物时MPS为1.12（范围0 - 3.2），取出时MPS为2.36（范围0 - 6.7）。这些结果与我们之前的发现无统计学差异。我们得出结论，术后鼻填塞仅2小时而非24小时可显著减轻疼痛，且不会增加出血风险。
