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Does Choice of Nasal Pack Matter? A Systematic Review and Meta-Analysis of Merocel and Rapid Rhino
Camille Duggal1, Kathleen Zang2, Hanieh Tavakkoli
1Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Objectives:
Epistaxis is one of the most common rhinological emergencies. Management often involves nasal packing when initial measures fail. This paper compares Rapid Rhino (RR) and Merocel in the management and prevention of epistaxis.
Data Sources:
Studies from Embase, PubMed and Medline were included.
Review Methods:
A systematic review and subsequent meta-analysis were performed, pre-registered on PROSPERO and adhering to PRISMA guidelines. Studies were screened, followed by data extraction and risk of bias assessment. The meta-analysis was performed using Stata. Pain score effect size was based on raw means at packing removal, while rebleeding effect size used Freeman-Tukey's proportion. Pain score at removal and rebleeding requiring repacking was assessed.
Results:
The systematic review yielded 4637 studies for screening, with 51 meeting inclusion criteria. In primary epistaxis, RR was associated with less pain upon insertion and removal. In the surgical setting, RR demonstrated superior hemostasis and greater patient comfort. The meta-analysis demonstrated that for post-surgical packing, RR was significantly less painful on removal than Merocel (Mean = 2.50 [1.72, 3.28] vs. 6.34 [5.58, 7.10]; p = 0.00). Similarly, for primary epistaxis, RR removal was significantly less painful than Merocel (Mean = 2.28 [0.95, 3.61] vs. 4.14 [3.31, 4.97]; p = 0.02). All tests of group differences for rebleeding demonstrated no significant differences between nasal packs.
Conclusion:
RR was found to be significantly less painful upon removal in primary and post-surgical epistaxis. Although the systematic review demonstrates that RR is associated with less bleeding than Merocel, the meta-analysis demonstrated no statistically significant difference.
