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

Abstract Objective: After 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®. Methods: This 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. Results: Computed 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. Conclusion: Physicians 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 evidence: Level 3.

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

OBJECTIVE: After 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®. METHODS: This 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. RESULTS: Computed 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. CONCLUSION: Physicians 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 EVIDENCE: Level 3.

Uso de profilaxis antibiótica en el taponamiento nasal, una revisión actualizada

Resumen El uso de profilaxis antibiótica en el taponamiento nasal es una práctica ampliamente usada por el eventual riesgo de síndrome de shock tóxico o complicaciones infecciosas locales. En los últimos años, se ha cuestionado su real impacto tomando en cuenta los riesgos asociados al uso de antibióticos y la baja o casi nula incidencia de las complicaciones infecciosas. Se realizó una revisión exhaustiva de la literatura sobre el uso de profilaxis antibiótica en taponamiento nasal. Se observó que no existían diferencias estadísticamente significativas en la incidencia de complicaciones infecciosas y no hubo reportes de síndrome de shock tóxico en ninguno de los grupos con y sin profilaxis antibiótica. No hubo diferencias significativas en los cultivos de los pacientes con o sin antibióticos en taponamiento nasal por epistaxis. El uso de profilaxis antibiótica en taponamiento nasal es una práctica cuestionable y se requieren más estudios al respecto.

Abstract Antibiotic prophylaxis in nasal packing is a widely used practice due to the possible risk of toxic shock syndrome and infectious complications. Lately, its real impact has been questioned due to the associated risks with antibiotic use and low incidence of infectious complications. A comprehensive review of the literature on the use of antibiotic prophylaxis in nasal packing was performed. No statistically significant differences in the incidence of infectious complications and no reports of toxic shock syndrome were reported in any of the groups with and without antibiotic prophylaxis. There were no significant differences in the antibiotic cultures of patients with or without prophylactic antibiotics in nasal packing due to epistaxis. The use of antibiotic prophylaxis in nasal packing is a questionable practice and further studies are required.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal / A influência do extrato de folha de hera seca na secreção nasal após remoção de tampão nasal pós-septoplastia

Abstract Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. Conclusion: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Resumo Introdução: Após a remoção do tampão nasal pós-septoplastia, ocorre produção de secreção nasal, predispondo infecções locais e, por vezes, sistêmicas. Objetivo: O objetivo foi determinar se a aplicação do extrato padronizado de folhas de hera seca após a remoção do tampão nasal influencia a redução da secreção nasal e diminui a ocorrência de infecções locais. Método: O estudo incluiu 70 pacientes pós-septoplastia (divididos em dois grupos iguais) cujo tampão nasal foi retirado no terceiro dia após o procedimento. O grupo I foi tratado com xarope padronizado de extrato de folha seca de hera juntamente com irrigação nasal regular por cinco dias após a remoção do tamponamento nasal, enquanto ao grupo II foi recomendado apenas lavagem nasal. No sexto dia após a remoção do tampão nasal, a quantidade de secreção nasal foi determinada pela escala EVA (escala visual analógica) e pelo exame endoscópico nasal. Resultados: O grupo tratado com xarope de extrato seco de folhas de hera apresentou secreção nasal significativamente menor tanto pela avaliação subjetiva dos pacientes (p < 0,001) quanto pelo exame endoscópico nasal (p = 0,003). O exame de acompanhamento pós-cirúrgico no sexto dia após a remoção do tampão nasal não mostrou desenvolvimento de infecção local nos pacientes do grupo I, enquanto que no grupo II, cinco apresentaram sinais de infecção local (14,29%) com necessidade de antibioticoterapia. Conclusão: O uso do extrato padronizado de folhas secas de hera após a remoção do tampão nasal reduz significativamente a produção de secreção nasal.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal.

INTRODUCTION: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. OBJECTIVE: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. METHODS: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. RESULTS: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p<0.001) and by nasal endoscopic examination (p=0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. CONCLUSION: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery / Sutura transeptal - uma alternativa custo-benefício para tamponamento nasal em cirurgia do septo

ABSTRACT INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Resumo Introdução: O tamponamento nasal é usado rotineiramente na cirurgia septal para evitar sangramentos no pós-operatório. Objetivo: Demonstrar a possibilidade de se realizar uma sutura transeptal como alternativa eficaz e segura ao tamponamento nasal, com melhora na eficiência da intervenção. Método: Este é um estudo prospectivo, descritivo e de custo inferencial, compreendendo 92 pacientes. Dois grupos aleatórios foram estudados: um com tamponamento nasal e o outro com sutura transeptal. Resultado: No grupo de sutura transeptal, nenhum paciente experimentou sangramento no pós-operatório, tendo sido estatisticamente demonstrada uma significante redução de cefaléia e dor. Ao mesmo tempo, houve melhora na eficiência da intervenção, com economia no custo de material. Conclusões: A sutura transeptal é uma alternativa eficaz e segura ao tamponamento nasal clássico. Além do mais, melhora a eficiência da intervenção, economizando no custo de material.

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery.

INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Septoplastia com ou sem tamponamento pós-operatório? Estudo prospectivo / Septoplasty with or without postoperative nasal packing? Prospective study

O tamponamento nasal anterior é efetuado num grande número de cirurgias nasais, nomeadamente na septoplastia. Contudo, não é um procedimento inócuo pelo que o seu benefício tem vindo a ser questionado. OBJETIVO: Avaliar a necessidade do tamponamento nasal anterior e a qualidade de vida nos doentes submetidos à septoplastia. MÉTODO: Doentes submetidos à septoplastia, com ou sem turbinoplastia inferior, foram randomizados para a colocação ou não de tamponamento nasal anterior no pós-operatório. Foram registados e comparados os dados relativos ao pós-operatório (dor, hemorragia). A qualidade de vida foi avaliada no pré e pós-operatório. Estudo prospetivo randomizado. RESULTADOS: Foram incluídos 73 doentes (37 tamponados e 36 não tamponados) com seguimento mínimo de 3 meses. Nos doentes tamponados, a dor nasal e as cefaleias no pós-operatório imediato foram superiores. Destes doentes, 75,7% referiram dor moderada/intensa no destamponamento. Nos doentes não tamponados, a hemorragia foi mais frequente, mas apenas um doente necessitou tamponamento. Houve melhoria da qualidade de vida em todos os doentes. CONCLUSÃO: A septoplastia melhora a qualidade de vida do doente com desvio do septo e obstrução nasal. O uso por rotina do tamponamento nasal anterior deve ser questionado por não apresentar benefício comprovado.

Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

Cirugía transnasal transesfenoidal endoscópica de la región selar sin taponamiento nasal: un procedimiento confortable y seguro para los pacientes / Transnasal transsphenoidal endoscopic surgery of the sellar region without nasal packing: a comfortable and safe procedure for patients

Se evalúan 15 cirugías endoscópicos transnasales en forma prospectiva en un período de 8 meses, entre Noviembre del 2006 y Julio del 2007, respecto del uso de taponaje nasal postoperatorio. El 86.5 por ciento de los pacientes operados fue por adenoma de hipófisis con una leve preponderancia del sexo femenino (61.5 por ciento) y un promedio de 53.9 años edad. En un 93.4 por ciento de los pacientes se dejó sin taponaje al término de la cirugía. El único paciente que se dejó con taponaje presentó una fístula de L.C.R. en el intra y post operatorio inmediato, que cedió con drenaje espinal continuo por 3 días. El promedio de estadía hospitalaria luego de la cirugía fue de 4.3 días, con un promedio de 2.4 días en la UCI (Unidad de Paciente Crítico). Se concluye que es un procedimiento altamente confortable para los pacientes y muy seguro, no presentando complicaciones secundarias al no uso de taponaje nasal.

We evaluated 15 transsphenoidal endoscopic surgeries in prospectlve form into 8 months, November 2006 to July 2007. The topic was the use of post operative nasal packing. The 86.5 percent of operated patienls was pituitary adenomas with slight predominance 10 females (61.5 percent) and 53.9 y.o. in average. In 93.4 percent of patients stayed wlthout nasal packing al the end of the surgery. The only patient who used nasal packing had cerebrospinal fluid leakage through out the sellar floor since the intraoperative procedure to initial postoperative care, ended with contlnuous spinal drainage for 3 days. The average days to be in the hospital after surgery were 4.3 days in total and 2.4 days in the intensive unit care. We concluded that the surgery without nasal packing is heightly comfortable and very safe for patients; we didn't see any secondary complicatlons for not using nasal packing.