A Pilot Randomized Controlled Trial in Management of Epistaxis Comparing Nasal Packing Versus Greater Palatine Foramen Block

Introduction:

The most common otorhinolaryngological emergency in primary care and emergency departments is epistaxis, which commonly causes severe anxiety in both patients and medical professionals. It shows a bimodal age distribution, with adults between the ages of 50 and 70 and children between the ages of 2 and 10 showing a higher occurrence. Nearly 6% of the general population needs medical attention, and about 60% of people have at least one episode of epistaxis in their lives. Because of its unpredictable clinical course, epistaxis can range in intensity from moderate, self-limiting episodes to severe hemorrhage, and in some situations, it may be deemed life-threatening.

The nasal cavity is vascularized by an extensive anastomotic circuit composed of branches from both the internal and external carotid arteries. The anterior nasal septum is supplied by the anterior and posterior ethmoidal arteries, the sphenopalatine, greater palatine, and superior labial arteries. These blood vessels create Kiesselbach's plexus, which is the most common source of anterior epistaxis. The sphenopalatine artery and terminal branches of the maxillary artery, which are commonly associated with posterior epistaxis, they nourish the posterior part of nasal septum and lateral nasal wall, respectively.

Managing epistaxis has been a major problem in otolaryngology for a long time. This nasal hemorrhagic condition can be attributed to various reasons, including trauma, localized nasal pathology, hematological disorders, systemic hypertension, anticoagulant therapy, and endoscopic sinus surgery. Despite the availability of many therapy modalities, a subset of patients develops epistaxis that is resistant to standard treatment, necessitating more advanced treatment techniques.

An accepted treatment for epistaxis that has not responded to initial hemostatic methods like pressure or cautery is nasal packing. Bismuth iodoform paraffin paste (BIPP) on ribbon gauze is among the most often used packaging materials. To efficiently pack the nasal cavity with BIPP, a certain level of anatomical expertise is required while utilizing a head light, the equipments, and packing the nasal cavity. Over the last three decades, merocel nasal packs have evolved the practise and are routinely used replacing the BIPP nasal packing for controlling epistaxis that failed initial hemostasis measures. The efficacy of Merocel packs in controlling bleeding has been marked as 91.5 % in the literature. Use of the correct insertion technique is very important. Both of these techniques have equivalent effectiveness to stop bleeding and there was no significant difference in efficacy or patient tolerance of either treatment. Such nasal packing techniques have a large learning curve during insertion. Moreover, the discomfort whilst in situ and on removal is non-negotiable.