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Local anaesthesia for manipulation of nasal fractures: systematic review

Published online by Cambridge University Press:  08 March 2017

N K Chadha ,
C Repanos  and
A J Carswell
N K Chadha*
Affiliation:
Department of ENT, Royal Devon and Exeter Hospital, Plymouth, UK
C Repanos
Affiliation:
Department of ENT, Royal Devon and Exeter Hospital, Plymouth, UK
A J Carswell
Affiliation:
Department of ENT, Derriford Hospital, Plymouth, UK
*
Address for correspondence: Mr Neil K Chadha, Department of ENT, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK. Fax: 07092022586 E-mail: neil@chadhanet.com
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Abstract

Objective:

To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia.

Method:

Systematic review and meta-analysis.

Databases:

Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials.

Included studies:

We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied.

Results:

Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia.

Conclusions:

Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.

Keywords

Nasal BonesManipulationNasal ObstructionCosmeticLocalAnaesthesiaGeneralSystematic Review
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 8 , August 2009 , pp. 830 - 836
Copyright
Copyright © JLO (1984) Limited 2009

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Footnotes

Presented at the Joint ENT UK and Royal Society of Medicine Annual Meeting, 7 September 2007, London, UK.

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