Audit of pain after nasal surgery

In our department, nasal packs have traditionally remained in place for a period of 24 h after routine elective nasal surgery. We decided to determine whether reducing the duration of nasal packing from 24 h to 2 h would reduce postoperative pain without a concomitant increase in haemorrhagic complications. A series of 72 patients undergoing elective nasal surgery were randomised to have either nasal packs for 24 h (n = 39) or for 2 h (n = 33). Pain was assessed using a visual analogue scale with the nasal packs in place and on their removal. The incidence of haemorrhage was noted. The results showed a significant decrease in mean pain score (MPS) with the packs in place, from 3.4 (range 0.8-6.8) to 1.16 (range 0-2.5); (P < 0.001) and also on pack removal from 5.3 (range 1.2-7.9) to 2.6 (range 0-5.4); (P < 0.05). There was no postoperative haemorrhage in either group. A new standard of 2 h for routine nasal packing was set and our departmental protocols were changed accordingly. Results in a further 36 patients gave a MPS with the packs in place of 1.12 (range 0-3.2) and a MPS of 2.36 (range 0-6.7) on their removal. There was no statistical difference between these and our previous findings. We conclude that postoperative nasal packing for only 2 h rather than 24 h significantly reduces pain without a concomitant risk of haemorrhage.