Naseptin or Cautery in adult epistaxis?

Report By: Catherine Jackson - ST5 EM
Search checked by Barbara Scobie - ST5 EM
Institution: UHSM
Date Submitted: 30th June 2010
Last Modified: 30th June 2010
Status: Blue (submitted but not checked)

Three Part Question

[In adults presenting to the emergency department with epistaxis] [would naseptin or cautery be superior] [in preventing reoccurrence?]

Clinical Scenario

A 60 year old gentleman presents to the emergency department with a spontaneous epistaxis.
The bleed is anterior, from one nostril and stops with simple pressure application
The patient is extremely concerned about this happening again asks what can be done to stop it?
You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?

Search Strategy

Medline using OVID interface 1950-Oct week 1 2010
{(exp epistaxis OR epistaxis.mp OR nosebleeds.mp) OR [(exp hemorrhage OR hemorrhage.mp OR haemorrhage.mp OR bleed.mp) AND (exp nose OR nose.mp OR exp nasal mucosa OR nasal mucosa.mp OR nasal.mp OR nares.mp)]} AND (exp cautery OR cautery.mp OR exp silver nitrate OR nasal cautery.mp OR exp anti-infective agents OR anti-infective agents.mp) LIMIT to human AND English AND adults

Search Outcome

176 papers found, 175 irrelevent

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Murthy P et al 1999 UK	66 consecutive patients with recurrent epistaxis	RCT	Improvement in symptoms	No statistical difference between cautery alone and naseptin and cautery	Small numbers Weak outcomes 16 subjuscts not included in analysis No method of recruitment stated

Comment(s)

The evidence in this field in sparse. There are no studies with directly compare naseptin and cautery alone. In addition there are no RCTs which compare the two interventions against no intervention at all.

Clinical Bottom Line

There is little clinical evidence to prove whether cautery or naseptin is superior in preventing the reoccurrence of epistaxis. More research is needed in this field.

References

P. Murthy, E. L. K. Nilssen, S. Rao & L. G. Mcclymont A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis Blackwell Publishing Dec 2001, pages 228-231