Nasal packing with bupivacaine during nasotracheal intubation can reduce intubation-related epistaxis

Abstract

Epistaxis often is caused by nasal mucosal damage and vascular injury after nasotracheal (NT) intubation. Bupivacaine constricts blood vessels at low concentrations and dilates them at high concentrations. In this study, in which we evaluated the effects of intranasal packing with bupivacaine to prevent epistaxis and pain induced by NT intubation, we classified 180 patients into three groups: an untreated group (n=60), a group pretreated with epinephrine (n=60), and a group pretreated with bupivacaine (n=60). In all groups, we used nasal Ring–Adair–Elwyn tubes with the thermosoftening method for NT intubation. We classified the degree of epistaxis as Grade 0 (none), Grade 1 (mild), Grade 2 (moderate), or Grade 3 (severe). We assessed postoperative visual analog scale (VAS) scores for nose pain in the recovery room. We found that the incidence of epistaxis in the group pretreated with bupivacaine was significantly less than was that of the untreated group (55% vs. 35%, p<0.05). Univariate logistic regression analysis revealed a reduction in epistaxis with bupivacaine nasal packing (odds ratio=0.689, 95% confidence interval=0.478, 0.992). Postoperative VAS scores after 30 minutes in the nasal area were lower in the group pretreated with bupivacaine than were those in the untreated group or the group pretreated with epinephrine (p<0.05). Therefore, we conclude that nasal packing with bupivacaine can help reduce epistaxis and nasal pain more effectively as compared to cases without pretreatment with this anesthetic.