Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos / Nasal packing in posterior epistaxis. Comparison of two methods

Objetivo: Evaluar la tolerancia y eficacia de 2 sistemas de taponamiento nasal para epistaxis posteriores refractarias. Pacientes y métodos: Estudio comparativo longitudinal y prospectivo de 5 años en pacientes que acudieron a Urgencias por epistaxis y precisaron taponamiento posterior. Se consideraron 2 grupos: uno atendido con un sistema de hinchado neumático bicameral (n=105); otro en el que se efectuó oclusión posterior con gasa accediendo por boca y refuerzo anterior (n=47). La tolerancia se midió mediante escala analógica de intensidad dolorosa durante la colocación y mantenimiento del tapón, así como por necesidad de analgesia. La eficacia se valoró por índices de resangrado, necesidad de medidas concomitantes, transfusión de hemoderivados y efectos secundarios. Resultados: En los pacientes con taponamiento hinchable la colocación fue significativamente más rápida (36±19s vs. 228±102s; p<0,001) y menos dolorosa (6,7±1,7 vs. 8,3±1,5; p<0,001), precisando menos analgesia hasta su retirada. El taponamiento de gasa presentó menor porcentaje de resangrados (17% Vs. 26%; p<0,001), menos necesidades de transfusión de hemoderivados (15% vs. 18%; p<0,001) o de otros procedimientos (4% vs. 11%; p<0,001). El gasto sanitario con este último fue menor (1327±202€ vs. 1648±318€; p<0,001) y generó menos complicaciones a corto y largo plazo. Conclusiones: El taponamiento posterior clásico con gasa resulta menos cómodo y rápido de adaptar, pero asegura un mayor porcentaje de éxitos en control de epistaxis, genera menos lesiones locales y reduce costes sanitarios con respecto al neumotaponamiento (AU)

Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. Patients and methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. Results: In patients with inflatable nasal packing its placement was significantly faster (36±19s vs. 228±102s; p<0.001) and less painful (6.7±1.7 vs. 8.3±1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327±202€ vs. 1648±318€; p<0.001) and it generated less short and long-term complications. Conclusions: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing (AU)

[Nasal packing in posterior epistaxis. Comparison of two methods]. / Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos.

OBJECTIVE: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. PATIENTS AND METHODS: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. RESULTS: In patients with inflatable nasal packing its placement was significantly faster (36+/-19s vs. 228+/-102 s; p<0.001) and less painful (6.7+/-1.7 vs. 8.3+/-1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327+/-202 euro vs. 1648+/-318 euro; p<0.001) and it generated less short and long-term complications CONCLUSIONS: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing.