Evaluation of the Severity of Pain Caused by Management of Epistaxis in the Tertiary Center Emergency Department

Reza  Erfanian; Hakima  Abdullah; Mahsa  Niknam; Zahra  Mokhtari; Hamed  Abdollahi; Maryam Keyfari  Alamdari

doi:10.18502/aacc.v11i4.19370

Reza Erfanian Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Hakima Abdullah Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Mahsa Niknam Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Mokhtari Department of Anesthesiology, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Hamed Abdollahi Department of Anesthesiology, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Maryam Keyfari Alamdari Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v11i4.19370

Keywords: Pain; Epistaxis; Nasal packing; Electrocautery; Xylocaine-prilocaine cream

Abstract

Background: Epistaxis can result from surgery, trauma, hypertension, hereditary hemorrhagic telangiectasia, or unknown reasons and can be treated in various ways. This study examined the pain severity related to epistaxis management in the emergency department of a tertiary otolaryngology facility.

Methods: This study was a descriptive and analytical cross-sectional analysis involving 129 patients. These patients were chosen from those referred to the emergency otolaryngology department for treatment of epistaxis. The treatment method was selected based on the severity of the epistaxis and whether a bleeding vessel was visible. Patients were categorized into nose pinching, anterior nasal packing, and bipolar electrocautery groups. For reducing pain from electrocautery and nasal packing, a mesh instilled with lidocaine and epinephrine is used before procedures. We assessed pain levels using a visual analog scale ranging from 0 to 10. We also studied the impact of xylocaine-prilocaine cream on reducing discomfort from anterior nasal packing in 42 patients who came to the emergency department with nosebleeds.

Results: The mean age of patients was 53.67 ± 19.96 years; 76 (57.6%) were male. Anterior nasal packing was the most common procedure for controlling epistaxis, with a mean pain severity of 6.61 (± 2.3). The pain score in the nostril-pinching group was significantly lower than in the other groups (P<0.001). In the second part of the study, the mean pain score in the xylocaine-prilocaine cream group was 4.52 ± 2.3, significantly lower than in the group without the cream (P<0.001).

Conclusion: According to the results, nasal packing was the most prevalent procedure for controlling epistaxis, which causes severe pain for patients. Application of xylocaine-prilocaine cream can reduce the severity of pain in comparison with lidocaine solution alone.