Comparison of ropivacaine, bupivacaine, prilocaine, and lidocaine in the management of pain and hemorrhage during nasal pack removal

Background: This study investigates the effects of local anesthetics application on pain and hemorrhage caused by nasal pack removal. Methods: The study included 140 patients. Of these, 72 were women and 68 were men. The mean age and weight of the patients were 33.67 +/- 10.2 years (range, 21-63 years) and 69.6 +/- 13.6 kg. The patients were divided randomly into four groups. Three of the four groups received one of the local anesthetics studied in our trial (lidocaine + adrenaline, 0.25% bupivacaine, or 2% prilocaine) before removal of the nasal packing material and the control group received saline solution. Local anesthetics and 0.9% saline solution were applied to Merocel nasal packs 15 minutes before removal. Each patient was given a questionnaire where verbal analog score and amount of postoperative hemorrhage was noted. Results: The mean pain score was 3.5 +/- 1.2 (median, 4; range, 3-5) in the lidocaine group, 4.5 +/- 1.2 (median, 4; range 3-5) in the prilocaine group, 4.7 +/- 1.3 (median, 6; range, 3-5) in the bupivacaine group, and 6.35 +/- 1.2 (median, 6; range, 5-7) in the saline group during nasal packing removal. The lidocaine group had significantly better pain scores versus other groups (p < 0.05). Bupivacaine and prilocaine had significantly better pain scores versus the control group, respectively. Analysis of bleeding scores after pack removal showed that all three study groups had significantly better bleeding scores versus the control saline group (p < 0.05). The lidocaine group had significantly less bleeding score than bupivacaine and prilocaine groups (p < 0.05). Conclusion: Topical lidocaine application before removal of nasal packs in patients who undergo nasal septal surgery can decrease discomfort and bleeding and improve patient tolerance.