Foam nasal packs: a prospective, randomised, patient-controlled study

To compare the efficacy of Spiggle and Merocel foam packs following routine nasal surgery.

Prospective, randomised, single-blind, paired study.

Twenty adult patients undergoing elective nasal surgery.

At the end of nasal surgery patients were randomised to have a Spiggle pack inserted in one nasal cavity and a Merocel pack in the other. Packs were removed the following morning.

The primary outcome measure was pain due to the presence of packs in the nose and pain associated with their removal. This was measured using a visual analogue scale. Secondary outcome measures were bleeding, crusting and adhesion formation.

Both packs were effective at preventing postoperative haemorrhage. Bleeding following removal was minimal. There were no significant differences between the packs in terms of levels of discomfort experienced 6 hours after surgery or the following morning prior to removal (p = 0.3 and p = 0.3 respectively). However, the Spiggle foam pack caused significantly less pain on removal compared with the Merocel foam pack (mean difference 1.4; 95% CI 0.4 to 2.4, p = 0.005). There were no significant differences in terms of crust and adhesion formation.

In this study, both the Spiggle and Merocel foam nasal packs were well tolerated while in the nose. Both provided good postoperative haemostasis and were not associated with bleeding on removal. The Spiggle foam pack had the advantage of causing significantly less pain on removal. However, it must be borne in mind that in this study the Spiggle pack was more likely to be positioned in the non-incised nasal cavity, the side that would generally be expected to be associated with less pain.