A study evaluating the effects of throat packs during nasal surgery: a randomised controlled trial

Abstract

The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6 h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6 h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6 h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6 h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.

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

“…14 Although pharyngeal pack is not universally adopted and is indeed rare in North America, 9 it has been a frequently used practice, especially in other European countries Turkey, Ireland, and so on as well as the United Kingdom, to minimize the risk of blood aspiration despite intubation cuff, as well as blood swallowing. 2,4 Previously, a review of pharyngeal pack usage for nasal surgery in 2009 assessed four randomized controlled trials and found that no study showed the efficacy of pharyngeal packing in terms of decreasing the incidence of PONV. 15 However, there were several problems with the analysis used in that review.…”

“…However, pharyngeal packing also has its own associated problems, such as postoperative throat pain. This adverse effect is thought to be due to the irritating characteristics of the packing material on the pharyngeal mucosa . The prevalence of sore throat following intubation varies from 14.4% to 50% and has been reported in up to 60% of cases when pharyngeal packs were applied .…”

“…This adverse effect is thought to be due to the irritating characteristics of the packing material on the pharyngeal mucosa. 4 The prevalence of sore throat following intubation varies from 14.4% to 50% and has been reported in up to 60% of cases when pharyngeal packs were applied. 5 As a result, some debate remains as to whether they should be used in medical centers.…”

The use of throat packs in pediatric cleft lip/palate surgery: a retrospective study

“…Al-Lami et al concluded that the use of throat packs does not confer PONV reduction benefit after nasal surgery in adult [ 9 ]. Postoperatively, patients filled out a validated questionnaire measuring degree of PONV and throat pain.…”

“…A recent randomized controlled trial was conducted to investigate the association between the use of throat packs and postoperative PONV (postoperative nausea and vomiting) and treat pain after nasal surgery in adult patients [ 9 ]. This randomized controlled trial concludes that throat packs do not lower the risk of postoperative nausea and vomiting and are associated with more throat pain in the immediate recovery period after nasal surgery.…”