Having had a septoplasty a number of years ago for the potential treatment of snoring, I was intrigued by this paper which compared the analgesic effect of tramadol-soaked and lignocaine-soaked nasal packs following septoplasty. In my practice, I have always tried to avoid the use of nasal packs following septoplasty so that patients can breathe through their nose to a certain extent. This study looked at 122 adult patients divided into three groups, using Merocel packs soaked with lignocaine, tramadol or normal saline (control). Outcomes were assessed using visual analogue scales at 5, 10, 15, 20, 30 and 40 minutes, and at 1, 2, 4, 6, 8, 12, and 24 hours. Breakthrough pain was treated with paracetamol and diclofenac. The control group required a statistically higher amount of breakthrough analgesia compared to the other two groups. Across multiple timepoints, tramadol-soaked packs gave better pain relief than the lignocaine or control groups. The dose of local tramadol used was 3mg/kg diluted in 10ml of normal saline and was applied to each pack in 5ml volumes. Some surgeons use Merocel packs following septoplasty and for them this may be a useful adjunct. However, many surgeons, including myself, generally try and avoid packs especially as the packs themselves can cause more discomfort. Following my own septoplasty (without packs), I used paracetamol and diclofencac and this seemed to adequately control my pain levels.

The effect of lidocaine and tramadol in nasal packs on pain after septoplasty.
Simsek T, Musaoglu I, Uluat A.
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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