The Efficacy of 4% Lidocaine in Reducing Pain during Nasal Packing Removal

Abstract

Background and Objectives: Nasal packing is almost dressed after endoscopic sinonasal surgery for preventing nasal rebleeding. Thereafter 24 hours surgery, it could be removed. Aim of this study was to investigate the efficacy of 4% Lidocaine on reducing pain during nasal packing removal in patients who underwent endoscopic nasal/sinus surgery.

Methods: A double blinded randomized controlled trial was conducted at Department of Otorhinolaryngology, Srinagarind hospital, Khon Kaen University. Patients who were packed with polyvinyl acetal nasal sponge in postoperative period between August 4th, 2011 and November 15th, 2012 were recruited. Concealed allocations between 4% lidocaine and 0.9% normal saline (placebo) were randomized. Before nasal packing removal, patients assessed their baseline pain scores and the medication either lidocaine or normal saline solution was applied on the nasal packing.  Pain score during nasal packing removal was assessed again.

Results: Sixty patients, aged between 21-74 years were recruited. There were 52 patients with mild pain and 8 patients with moderate pain on baseline score. For patients with baseline mild pain score, the group of normal saline had lower mean difference of pain score (p = 0.142); conversely, for those with moderate pain score, the group of lidocaine had lower mean difference of pain score (p = 0.089). No severe complications were observed.

Conclusion: In moderate baseline pain score group, the lidocaine trend to reduce pain; however, there was no statistically significant difference due to small sample size. Therefore, further research should be conducted.