Tevfik SÖZEN, Övsen ÖNAY, Seyit Mehmet CEYLAN

Surgicel ® kullanımının epistaksis kontrolünde nazal tampon ile karşılaştırılması

Amaç: Transseptal sütürasyon ile Surgicel ® tatbikinin burun kanamasındaki etkinliğinin ve tolere edilebilirliğinin belirlenmesi.Metod: Ocak 2015 ile Ağustos 2016 tarihleri arasında Kiesselbach bölgesinden kanaması tespit edilen ve tedavi edilen hastalar retrospektif olarak tarandı. Tedavide anterior nazal tampon (Merocel®) uygulanmış 18 hasta, transseptal sütürasyon ile Surgicel ® tatbiki yapılmış olan 16 hasta çalışmaya dahil edildi. Hastaların kontrol vizitlerinde NRS-11 morbidite skalası kullanılarak elde edilmiş olan veriler, kişinin tecrübe ettiği ağrı ve yapılan işleme gösterdiği uyumu kıyaslamada kullanıldı. Bulgular: İki grup arasında kanama rekürrensi açısından istatiksel olarak anlamlı fark bulunmadı. Transseptal sütürasyon ile Surgicel ® tatbikinin nazal tampona kıyasla daha iyi tolere edildiği ve düşük morbiditeye sahip olduğu görüldü. Sonuç: Anterior epistaksiste transseptal sütürasyon ile Surgicel ® tatbikinin etkili ve iyi tolere edilebilir alternatif bir prosedür olduğu görüldü.

Anahtar Kelimeler:

Nazal tampon, epistaksis, burun kanaması

Comparing efficacy of Surgicel ® application with nasal packing in epistaxis

Aim: To evaluate the efficacy and tolerability of Surgicel ® application with transseptal suturing in epistaxis.Methods: Thirty-four patients who underwent therapy for epistaxis from Kiesselbach’s area, between January 2015 and August 2016, were retrospectively analyzed. As a treatment modality, anterior nasal packing (Merocel® tampon with airway) was inserted to 18 patients, and transseptal suturing combined with the Surgicel ® application was performed in 16 patients. The pain experienced during the procedure and compliance of the patients was evaluated using the NRS-11 morbidity scale that was administered during the control visits.Results: No significant difference was identified between the two groups regarding the efficacy of bleeding control. Transseptal suturing combined with the Surgicel ® application was tolerated better and had lower morbidity compared to nasal packing. Conclusion: This study showed that transseptal suturing with the Surgicel ® application is an effective and well-tolerated procedure in the treatment of anterior epistaxis.

Keywords:

Nasal packing, epistaxis, nasal bleeding,

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1. Pallin D, Chng Y, McKay M, Emond J, Pelletier A, Camargo C. Epidemiology of epistaxis in US emergency departments 1992 to 2001. Ann Emerg Med. 2005;46:77–81.
2. Vhichweg T, Roberson J, Hudson J. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg. 2006; 64:511–8.
3. Ha J, Hodge J, Lewis R. Comparison of nasendoscopic-assisted cautery versus packing for the treatment of epistaxis. ANZ J Surg. 2011;81:336-9.
4. Bahreini M, Jalili M, Morafi-Lakeh M. A comparison of three self-reported pain scales in adults with acute pain. J Pain. 2013;14:1653-62.
5. Duncan I, Fourie P, Ic Grange C, Van der Walt H. Endovascular treatment of intractable epistaxis results of a 4 year local audit. S Afr Med J. 2004;94:373-8.
6. McGarry G, Moulton C. The first aid management of epistaxis by accident and emergency department staff. Arc of Emerg Med.1993;10:290-300.
7. Farneti P, Pasquini E, Sciarretta V, Macrì G, Gramellini G, Pirodda A. Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis. Clin Exp Otorhinolaryngol. 2016; 9:131-5.
8. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician. 2005;71:305–11.
9. Morgan DJ, Kellerman R. Epistaxis: evaluation and treatment. Prim Care. 2014;41:63–73.
10. Toner JG, Walby AP. Comparison of electro and chemical cautery in the treatment of anterior epistaxis. J Laryngol Otol. 1990;104:617–8.
11. Stangerup SE, Dommerby H, Lau T. Hot water irrigation as a treatment of posterior epistaxis? Rhinology. 1996;34:18-20.
12. Meric A, Korkut AY, Kahya V, Gedikli O. Prospective, randomized, controlled clinical trial of Ankaferd Blood Stopper in patients with acute anterior epistaxis. Eur Arch Otorhinolaryngol. 2010; 267:1377–81.
13. Certal V, Silva H, Santos T, Correia A, Carvalho C. Trans-septal suturing technique in septoplasty: a systematic review and meta-analysis. Rhinology. 2012;50:236-45.
14. Zayyan E, Bajin MD, Aytemir K, Yılmaz T. The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway. Laryngoscope. 2010;120:2325-30.
15. Dubin MR, Pletcher SD. Postoperative packing after septoplasty: is it necessary? Otolaryngol Clin North Am. 2009;42:279-85.
16. Al-Shaikh S, Muddaiah A, Lee RJ, Bhutta MF. Oxidised cellulose powder for haemostasis following sinus surgery: a pilot randomised trial. J Laryngol Otol. 2014;128:709-13.
17. Valentine R, Wormald PJ, Sindwani R. Advances in absorbable biomaterials and nasal packing. Otolaryngol Clin North Am. 2009;42:813-28.
18. Lewis KM, Spazierer D, Urban MD, Lin L, Redl H, Goppelt A. Comparison of regenerated and non-regenerated oxidized cellulose hemostatic agents. Eur Surg. 2013;45:213-20.
19. Bhatnagar RK, Berry S. Selective Surgicel ® packing for the treatment of posterior epistaxis. Ear Nose Throat J. 2004;83:633-4.
20. Günaydın RÖ, Aygenc E, Karakullukcu S, Fidan F, Celikkanat S. Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives. Eur Arch Otorhinolaryngol. 2011;268:1151-6.
21. Certal V, Silva H, Santos T, Correia A, Carvalho C. Trans-septal suturing technique in septoplasty: a systematic review and meta-analysis. Rhinology. 2012;50:236-45.
22. Wysocki J, Niszczota CS. Use of trans-septal mattress suture of Little's area for anterior epistaxis. J Laryngol Otol. 2011;125:399-401.
23. Newton E, Lasso A, Petrcich W, Kilty S.J. An outcomes analysis of anterior epistaxis management in the emergency department. J Otolaryngol Head Neck Surg. 2016;45:24.
24. Gallo A, Moi R, Minni A, Simonelli M, DeVincentiis M. Otorhinolaryngology emergency unitcare: the experience of a large university hospital in Italy. ENT J. 2000;79: 155–60.
25. Traboulsi H, Alam E, Hadi U. Changing Trends in the Management of Epistaxis. Int J Otolaryngol. 2015; 2015:263987.
26. Hady MR, Kodeira KZ, Nasef AH. The effect of nasal packing on arterial blood gases and acid-base balance and its clinical importance. J Laryngol Otol. 1983;97:599-604.
27. Schaitkin B, Strauss M, Houck J R. Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. Laryngoscope. 1987;97:1392–96.
28. Aslan G, Güvenç MG, Sapçi T, Candan S. Use of nasal bivalve septal teflon splint for the treatment of recurrent epistaxis in patients undergoing anticoagulant therapy. Rhinology. 2009;47:141-3.
29. Huggins S. Control of hemorrhage in otorhinolaryngologic surgery with oxidized regenerated cellulose. Eye Ear Nose Throat Mon. 1969;48:420-3.
30. Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope. 2005;115: 899-902.
31. ZhengHua Z , Gang F, BingWei Z, JiaWen C. Suturing of Little's area of the nasal septum for epistaxis. J Laryngol Otol. 2009;123:787-8.