Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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A prospective randomized trial of xylometazoline drops and epinephrine merocele nasal pack for reducing epistaxis during nasotracheal intubation

  • Patel, Sonam (Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Hazarika, Amarjyoti (Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Agrawal, Prachi (Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Jain, Divya (Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research (PGIMER)) ;
  • Panda, Naresh Kumar (Department of Otorhinolaryngology, Post-Graduate Institute of Medical Education and Research (PGIMER))
  • Received : 2020.05.21
  • Accepted : 2020.07.15
  • Published : 2020.08.31
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Abstract

Background: The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods: Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results: We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion: The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

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