Randomized controlled trial comparing Merocel® and Rapid-Rhino® packing in the management of anterior epistaxis

Objectives: A prospective non-blinded randomized controlled trial to compare the efficacy of Merocel(R) and Rapid-Rhino(R) nasal packs in the treatment of anterior epistaxis. Methods: Fifty-two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Haemostatic properties of the packs were measured by grading bleeding during and after removal of the pack (0-4, where four is uncontrollable) and by noting if the nose was re-packed or not. The difficulty of insertion and removal (graded 0-3 by clinician where 3 is the most difficult) and the participant's perception of discomfort (graded 0-10, where 10 is the worst pain) during insertion and removal of the pack were also measured. Results: For bleeding, the mean values for Merocel(R) and RapidRhino(R) during packing and after pack removal were not significant (P = 0.38 and 0.82 respectively). The mean values of patient discomfort on insertion were 6.9 and 5.0 (P = 0.01), and for discomfort on removal were 4.6 and 3.4 (P = 0.05) respectively. The mean values of insertion graded by the clinician were 1.7 and 0.9 (P = 0.0003), and for removal were 1.4 and 0.4 (P < 0.0001). Conclusions: RapidRhino(R) and Merocel(R) are equally effective in the control of anterior epistaxis but RapidRhino(R) is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.