Page-226 Original Article ABSTRACT Objective: To evaluate the anxiety experienced before, during and after conventional paraffin gauze nasal pack removal in patients operated under local versus general anesthesia. Study design: Comparative study. Place and duration of study: Department of ENT, Combined Military Hospital Sialkot and PAF Hospital Shorkot from July 2017 to June 2018. Material and methods: A total of 120 patients planned for Septoplasty were enrolled and divided into two groups. Sixty patients were to be operated under local anesthesia (Group A) while the other 60 were undergoing the same procedure under general anesthesia (Group B). Conventional paraffin gauze nasal packing was done for 24 hours in all 120 patients. Hamilton Anxiety Rating Scale (HAM-A) was used to determine the patients’ anxiety in both groups, 1 hour pre-operatively, immediately before and 1 hour after nasal pack removal. Results: The mean Hamilton Anxiety Scale assessment scores in both groups were of ‘mild’ category. The highest scores in both groups were observed immediately before nasal pack removal, with a range of 15-18, while the lowest scores in both groups were documented one hour after pack removal with a range of 13-16. Anxiety level in patients operated under general anesthesia was slightly lower than patients administered local anesthesia mean score of 16.40 ± 0.763 vs 17.21 ± 0.666 (p<0.001). Conclusion: Anxiety during nasal pack removal is mainly associated with prior pain experienced during nasal pack insertion. It is recommended that proper analgesia, adequate topical anesthesia, gentle insertion would make this process less distressing and will subsequently result in less anxiety at its removal. Keywords: Anxiety, Nasal Surgery, Nasal Packing, Septoplasty, Post-Operative Care INTRODUCTION: The earliest recorded reference to the use of nasal packing is found in the writings of Hippocrates in controlling epistaxis 1 . Nasal packing is commonly used to control bleeding following nasal surgery like septoplasty, turbinoplasty and functional endoscopic sinus surgery (FESS). An ideal nasal pack should cause minimal discomfort at insertion, exhibit a good splinting effect, control bleeding, and have minimal complications 2 . Nasal packing has some inherent disadvantages, such as causing discomfort, pain, nasal mucosal damage, septal perforation, allergic reaction, sleep/respiratory disturbances and decreased arterial oxygen saturation during sleep. Traumatic insertion of nasal packs can also result in iatrogenic bleeding 3 . Attempts have been made to produce materials that will address these problems, including removable and absorbable packing, and a multitude of nasal packing materials has emerged in recent years 4 . It is estimated that 60–80% of surgical patients experience substantial anxiety prior to surgery. Apart from pathophysi- ological responses such as hypertension and dysrhythmias, anxiety may also worsen the patients' perception of pain and may impede overall perioperative satisfaction 5 . Anxiety is a feeling of apprehension and fear, characterized by physical symptoms such as palpitations, sweating, and feelings of stress. Patient’s anxiety can be measured objectively using various tests e.g., Hamilton Anxiety Rating Scale (HAM-A), State-Trait Anxiety Inventory Clinical Assessment Scale (STAI-S) and Hospital Anxiety Depression Scale (HADS). We used Hamilton Anxiety Scale (HAM- A) in our study. It is our experience that those patients who had their nasal packing performed under Local anesthesia, having experienced the discomfort at insertion, have more anxiety because of the distressing memory, prior to their removal. On the other hand, patients who were operated under general anesthesia, being unaware of the discomfort at the time of nasal packing exhibit lesser anxiety prior to removal of the nasal packs. Search of the internet revealed a paucity of Amer Sabih Hydri, Muhammad Junaid Alam, Iqbal Hussain Udaipurwala, Furqan Mirza JBUMDC 2018; 8(4):226-230 Evaluation Of Anxiety During Nasal Pack Removal In Patients Operated Under Local Versus General Anesthesia Amer Sabih Hydri Associate Professor, Head of ENT Department, Combined Military Hospital, Sialkot. e-mail: draamerhydri@gmail.com Muhammad Junaid Alam ENT Department, PAF Hospital Shorkot Iqbal Hussain Udaipurwala Professor, Head of ENT Department Bahria University Medical Dental College Karachi. Furqan Mirza Assistant Professor, Jinnah Medical and Dental College Karachi Received: 13-08-2018 Accepted: 26-09-2018 DOI: https://doi.org/10.51985/JBUMDC2018070