An evaluation of Merocel and Series 5000 nasal packs in patients following nasal surgery: a prospective randomised trial Bresnihan, M.,* Mehigan, B., † & Curran, A.* *Department of ENT, St Vincents University Hospital, Elm Park, Dublin 4, Ireland, and † St James Hospital, Dublin 8, Ireland Accepted 6 July 2007 Clin. Otolaryngol. 2007, 32, 352–355 Objective: The primary objective of this study was to compare postoperative pain levels between Merocel and Series 5000 nasal packs. Design: A prospective randomised, single blind, paired control trial. Setting: A single consultant in two tertiary Otolaryngol- ogy units. Participants: Twenty-four adults, ASA 1, who underwent septoplasty, endoscopic sinus surgery or both, were considered after exclusion criteria were applied: bleeding abnormalities, patients taking anticoagulant medications and any significant co-morbidity requiring admission beyond 24-h postoperatively. Twenty-one patients were randomly assigned to have one side of their nose packed with Merocel pack and the other with Series 5000 overnight. Main outcome measures: The difference in pain levels, using a visual analogue scale, both with the pack in situ and on removal. Results: In 20 patients, the mean pain scores while the packs were in situ were 3.78 for Merocel and 3.62 for Series 5000 and was not found to be significantly differ- ent (P ¼ 0.65. 95% CI ¼ )0.57–0.89). The mean pain score on removal of the Merocel pack was five and for the Series 5000 was 3.08. The Series 5000 pack was signif- icantly less painful than Merocel on removal (P < 0.0001. 95% CI ¼ 1.11–2.7). Both were equally effective in their stability and haemostatic effect. Conclusions: Both the Merocel and Series 5000 packs are effective packs regarding haemostasis and have equivalent pain levels while in situ. However, the Series 5000 pack was significantly less painful on removal of the pack. Background Nasal packs are placed following nasal surgery to arrest haemorrhage, prevent septal haematoma formation and prevent postoperative adhesion formation by medialising the middle turbinate. The ideal packs should be easy to insert and remove without causing discomfort. Also they should be comfortable when in place, should prevent postoperative bleeding without damaging the mucous membrane of the nose and should provoke minimal tis- sue reaction. 1 Almost all ENT units use nasal packs whether it be for control of primary epistaxis or after nasal surgery. A variety of nasal packs are used but there is a surprising paucity of studies in the literature compar- ing nasal packs despite their widespread use. The aim of this study was to compare postoperative pain levels between Merocel Ò (Medtronic XOMED, Jacksonville, FL, USA) and Series 5000 (Network Medi- cal Products Ltd, Ripon, UK) nasal packs. These two packs are very similar (Fig. 1). Both are tampons constructed from a foam polymer of hydroxylated polyvinyl acetate and are of identical dimensions. The Series 5000 pack has a plastic coating, which is purported to be less abrasive and hence associated with less pain. Merocel packs were chosen as the compara- tive pack because of their similarity to Series 5000 and as they are widely used because of their ease of insertion. Materials and methods Participants All adults undergoing either septoplasty, bilateral func- tional endoscopic sinus surgery or both and who were Correspondence: Mary Bresnihan, Department of ENT, St Vincents University Hospital, Elm Park, Dublin 4, Ireland, Tel.: +353 01 2094277; e-mail: marybresnihan@rcsi.ie. ORIGINAL ARTICLE Ó 2007 The Authors 352 Journal compilation Ó 2007 Blackwell Publishing Limited, Clinical Otolaryngology, 32, 352–355