Control of anterior epistaxis: A comparative analysis of the decongestive effect of xylometazoline and adrenaline in idiopathic epistaxis in emergency settings

Abstract

Objective: To compare the impact of decongestive effect of xylometazoline and adrenaline in controlling active idiopathic anterior epistaxis on adult patients prior to use silver nitrate for cauterization. Study design: Prospective case study. Methods: The study used a prospective review of 150 consecutive adult patients diagnosed as anterior epistaxis (from August 2010 to January 2011). The study group was analyzed in three groups based on method of intervention used for management of anterior epistaxis. The conventional method of pinching nose and use of xylometazoline (0.5%) or adrenaline (1:10,000) soaked cotton packs for control of active arterial spurt followed in each case with silver nitrate cauterization. Results: A total of 150 patients reviewed who were medically fit and subjected to study design in three groups. Fifty adult patients in each group with similar presentation. In first group, 32 patients out of 50 (64%) had successful control of bleeding with silver nitrate cauterization only after pinching nose (for 10 minutes). In second group, it was seen that 43 patients out of 50 (86%) in one group had successful control of bleeding following use of 0.5% xylometazoline-soaked cotton packs (for 10 minutes). prior to silver nitrate cauterization. In another group, 45 patients out of 50 (90%) had successful control of bleeding following use of 1:10,000 adrenaline-soaked cotton packs (for 10 minutes) prior to silver nitrate cauterization. Conclusions: 1. Almost all patients with idiopathic anterior epistaxis can be managed more effectively and successfully by the use of vasoconstrictive agents followed by silver nitrate cauterization and risks of anterior nasal packing can be avoided. 2. The success rate of silver nitrate cauterization can be increased significantly with use of vasoconstrictive agents (xylometazoline and adrenaline) for control of actively bleeding arterial spurts prior to cauterization. 3. With the use of adrenaline not suitable in high-risk group patients, like coronary artery disease, cerebrovascular diseases, myocarditis, drugs like beta blockers, tricyclic antidepressants; xylometazoline can safely replace adrenaline in these cases.