Immediate and short-term outcome of septoplasty with nasal packing with reference to the effect of arterial blood gases’ concentrations

• Main Authors: Mohamed A Fatahalla, Ashraf A Wahba, Mahmoud M Elsayed
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Al-Azhar Assiut Medical Journal
• Subjects: arterial blood gases; nasal packing; nasal septoplasty
• Online Access: http://www.azmj.eg.net/article.asp?issn=1687-1693;year=2018;volume=16;issue=4;spage=333;epage=342;aulast=Fatahalla
• ISSN: 1687-1693

Objectives To evaluate the outcome of septoplasty and the effect of bilateral anterior nasal packing (NP) on surgical outcome and postoperative (PO) arterial blood gas levels. Patients and methods A total of 90 patients underwent septoplasty: group I included patients who received PO bilateral anterior NP at the end of surgery for 48 h and group II included patients free of NP. Patients were evaluated clinically using the Nasal Obstruction and Septoplasty Effectiveness scale and underwent septoplasty using Cottle’s technique. Arterial blood samples were obtained preoperatively and before NP removal for estimation of arterial blood pH, bicarbonate (HCO3−), partial pressure of O2 (PaO2) and CO2 (PaCO2), and O2 saturation (SaO2) levels. Pain severity was assessed using numeric rating scale at 6 h, D-1, and D-2 PO, and during the first 48 h PO, nasal bleeding in group II was estimated. After NP removal, pack removal-associated pain and amount of bleeding were determined. Results Operations were conducted uneventfully with nonsignificant difference between groups. At 48 h PO, mean PaO2, PaCO2, and SaO2 levels were significantly lower in all patients than preoperative levels, with significantly lower SaO2 and PaCO2 levels in patients of group I than group II. Numeric rating scale pain scores in both groups showed progressive significant decrease till 48 h PO, with significantly lower scores in group II. Removal of NP resulted in pain scored by more than or equal to 4 in 30 patients and induced minimal bleeding, which was significantly lower than bleeding occurred in patients of group II throughout the 48 h PO. All patients enjoyed significant reduction of Nasal Obstruction and Septoplasty Effectiveness score, with nonsignificant difference between both groups. Conclusion NP after septoplasty reduced amount of PO bleeding, but pain associated with NP presence and removal-induced deleterious effect on patients’ satisfaction with deleterious effect on arterial blood O2 and CO2 levels but with nonsignificant effect on arterial blood pH or HCO3 concentration.