Does Type of Pharyngeal Packing during Sinonasal Surgery Have an Effect on PONV and Throat Pain?

Meço, Başak Ceyda; Özçelik, Menekşe; Güçlü, Çiğdem Yıldırım; Beton, Süha; İslamoğlu, Yüce; Turgay, Aysegul; Meço, Cem; Batislam, Yeşim

doi:10.1177/0194599815626126

Cited by 28 publications

(46 citation statements)

References 10 publications

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“…The outcomes at the early (immediate postoperative recovery state) and middle (2 hours postoperative) stages showed reciprocal patterns; however, the total amount of administered antiemetics within 24 hours postoperative was statistically similar between the two groups. Although ingested blood is a very potent emetic, PONV is multifactorial, involving elements such as individual patient factors, intraoperative management, and postoperative care . Thus, the use of pharyngeal packs in nasal surgery theoretically could prevent the ingestion of blood, thereby reducing PONV.…”

Section: Discussionmentioning

confidence: 99%

“…The side effects and complications of oropharyngeal packing are primarily throat pain and mucosal injury. The primary outcome for this meta‐analysis was the incidence of moderate‐to‐severe PONV during the first postoperative day after nasal surgery under general anesthesia . Outcomes associated with pharyngeal packing during nasal surgery were compared against a control (no packing).…”

Section: Methodsmentioning

confidence: 99%

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Can Pharyngeal Packing Prevent Postoperative Nausea and Vomiting in Nasal Surgery?

2018

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Objectives We aimed to perform a meta‐analysis for the efficacy of pharyngeal packing during nasal surgery in the prevention of postoperative nausea and vomiting (PONV). Data Sources MEDLINE, SCOPUS, and the Cochrane database. Methods Two authors independently searched the databases for relevant studies from inception to October 2017. Included studies were randomized controlled studies published in English comparing pharyngeal packing during intubation (packing group) with no packing (control group) in patients who underwent nasal surgery. Outcomes of interest included the incidence of PONV and throat pain during the first 24 hours postsurgery. Results Ten studies were included in the meta‐analysis. The incidence of moderate‐to‐severe PONV in the recovery room was significantly higher in the packing group than in the control group. However, the incidence of moderate‐to‐severe PONV significantly decreased and was lower in the packing group than in the control group at 2 hours postoperative. The incidence of throat pain was higher in the packing group than in the control group until 2 hours postoperative. Conclusions Considering the occurrence of postoperative morbidity according to the time course, pharyngeal packing during nasal surgery does not alleviate PONV but instead could aggravate postoperative throat pain. Additionally, pharyngeal packing has the possibility of airway problem such as the foreign body aspiration. Based on our results, we suggest that there is no need to place a pharyngeal pack to prevent PONV in patients undergoing nasal surgery. Level of Evidence 1b Laryngoscope, 129:291–298, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Can Pharyngeal Packing Prevent Postoperative Nausea and Vomiting in Nasal Surgery?

2018

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“…Therefore, it would be necessary to evaluate the favorable effect or adverse effect of tranexamic acid in nasal surgery. Additionally, the incidence of postoperative nausea and vomiting (PONV) after nasal surgery has been reported to be 34% to 65% in various studies, which would be higher than 20% to 30% of incidence of PONV in all surgical patients after general anesthesia . In particular, because the nose and paranasal sinuses are highly vascularized structures, operations involving these regions may cause significant bleeding .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Kim

Kang

et al. 2018

The Laryngoscope

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Objectives Tranexamic acid might help control bleeding during surgery because of antifibrinolytic characteristics. We aimed to evaluate the effectiveness of systemic tranexamic acid compared to control in blood loss, operative time, and surgical field and incidence of postoperative emesis and thromboembolism in endoscopic sinus surgery. Methods Two authors independently searched six databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their inception to July 2018. The included studies compared perioperative tranexamic acid administration (treatment group) with a placebo, and the outcomes of interest were intraoperative morbidities, including surgical time, operative bleeding, and hypotension; postoperative morbidities such as nausea and vomiting; and coagulation profiles. Results Seven studies comprising 562 participants were reviewed in this study. Operative time (standardized mean difference (SMD) = −0.60; 95% confidence interval (CI)[−0.93, −0.29]) and intraoperative blood loss (SMD = −0.66; 95% CI [−0.86, −0.46]) were statistically lower in the treatment group than placebo group; and the quality of the surgical field (SMD = −0.80; 95% CI [−1.12; −0.48]) and surgeon satisfaction (SMD = 1.74; 95% CI [1.36; 2.13]) were statistically higher in the treatment group than the placebo group. By contrast, there were no significant differences in the hemodynamic (SMD = 0.08; 95% CI [−0.20; 0.37]) and coagulation profiles (SMD = −0.18; 95% CI [−0.42, 0.07]) of the two groups. Additionally, tranexamic acid had no significant effect on emetic or thrombotic events compared to placebo. Conclusion This meta‐analysis showed that the systemic administration of tranexamic acid could decrease operative time and blood loss intraoperatively, increasing the satisfaction of surgeons. It did not provoke intraoperative hemodynamic instability, postoperative emetic events, or coagulation profile abnormality. Only a small number of studies were enrolled, so further trials are needed to confirm the results of this study. Laryngoscope, 129:800–807, 2019

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“…It concluded that further adequately powered trials are needed to confirm the effect of pharyngeal packing on throat pain and PONV . Following this review, three randomised controlled trials with relatively large number of patients showed that hypopharyngeal packs have no effect on throat pain and PONV . This contradicts the results of Erkalp et al, who reported that hypopharyngeal packs can result in significantly increased incidence of aphthous stomatitis and throat pain in the first 3 days following nasal surgery.…”

Section: Discussionmentioning

confidence: 86%

“…Basha et al and Karbasforushan et al compared the use of hypopharyngeal pack with no pack, and they found that hypopharyngeal packing is associated with a significantly increased incidence of postoperative throat pain. Contradictorily, other studies concluded that pharyngeal packs have no effect on postoperative throat pain …”

Section: Introductionmentioning

confidence: 99%

Nasopharyngeal versus hypopharyngeal packing during sino‐nasal surgeries: Randomised controlled trial

Alfiky

Margalani

Rajeh

et al. 2018

Clinical Otolaryngology

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Does Type of Pharyngeal Packing during Sinonasal Surgery Have an Effect on PONV and Throat Pain?

Abstract: Despite commonly used practices, usage of different types of pharyngeal packing did not affect incidence of PONV and throat pain, nor did usage of no packing.

Cited by 28 publications

References 10 publications

Can Pharyngeal Packing Prevent Postoperative Nausea and Vomiting in Nasal Surgery?

Can Pharyngeal Packing Prevent Postoperative Nausea and Vomiting in Nasal Surgery?

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Nasopharyngeal versus hypopharyngeal packing during sino‐nasal surgeries: Randomised controlled trial

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