Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-13T10:30:54.242Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

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

References

1 Hussain, K, Wijetunge, DB, Grubnic, S, Jackson, IT. A comprehensive analysis of craniofacial trauma. J Trauma 1994;36:34–47CrossRefGoogle ScholarPubMed
2 Muraoka, M, Nakai, Y, Shimada, K, Nakaki, Y. Ten-year statistics and observation of facial bone fracture. Acta Otolaryngol Suppl 1991;486:217–23CrossRefGoogle ScholarPubMed
3 Scherer, M, Sullivan, WG, Smith, DJ Jr, Phillips, LG, Robson, MC. An analysis of 1,423 facial fractures in 788 patients at an urban trauma center. J Trauma 1989;29:388–90CrossRefGoogle ScholarPubMed
4 Logan, M, O'Driscoll, K, Masterson, J. The utility of nasal bone radiographs in nasal trauma. Clin Radiol 1994;49:192–4Google Scholar
5 Murray, JA, Maran, AG, Mackenzie, IJ, Raab, G. Open v closed reduction of the fractured nose. Arch Otolaryngol 1984;110:797–802Google Scholar
6 Watson, DJ, Parker, AJ, Slack, RW, Griffiths, MV. Local versus general anaesthetic in the management of the fractured nose. Clin Otolaryngol Allied Sci 1988;13:491–4Google Scholar
7 Cook, JA, McRae, RD, Irving, RM, Dowie, LN. A randomized comparison of manipulation of the fractured nose under local and general anaesthesia. Clin Otolaryngol Allied Sci 1990;15:343–6Google Scholar
8 Khwaja, S, Pahade, AV, Luff, D, Green, MW, Green, KM. Nasal fracture reduction: local versus general anaesthesia. Rhinology 2007;45:83–8Google Scholar
9 Cook, JA, Murrant, NJ, Evans, K, Lavelle, RJ. Manipulation of the fractured nose under local anaesthesia. Clin Otolaryngol Allied Sci 1992;17:337–40CrossRefGoogle ScholarPubMed
10 Jones, TM, Nandapalan, V. Manipulation of the fractured nose: a comparison of local infiltration anaesthesia and topical local anaesthesia. Clin Otolaryngol Allied Sci 1999;24:443–6CrossRefGoogle Scholar
11 Seltzer, AP. Depressed nasal fractures. A simple surgical technique. J Natl Med Assoc 1973;65:420–1Google Scholar
12 Murray, JA, Maran, AG. The treatment of nasal injuries by manipulation. J Laryngol Otol 1980;94:1405–10CrossRefGoogle ScholarPubMed
13 Dickson, MG, Sharpe, DT. A prospective study of nasal fractures. J Laryngol Otol 1986;100:543–51Google Scholar
14 Waldron, J, Mitchell, DB, Ford, G. Reduction of fractured nasal bones; local versus general anaesthesia. Clin Otolaryngol Allied Sci 1989;14:357–9CrossRefGoogle ScholarPubMed
15 el-Kholy, A. Manipulation of the fractured nose using topical local anaesthesia. J Laryngol Otol 1989;103:580–1Google Scholar
16 Owen, GO, Parker, AJ, Watson, DJ. Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient? Rhinology 1992;30:89–96Google Scholar
17 Newton, CR, White, PS. Nasal manipulation with intravenous sedation. Is it an acceptable and effective treatment? Rhinology 1998;36:114–16Google Scholar
18 Cox, AJ 3rd. Nasal fractures – the details. Facial Plast Surg 2000;16:87–94Google Scholar
19 Ashoor, AJ, Alkhars, FA. Nasal bone fracture. Saudi Med J 2000;21:471–4Google Scholar
20 Green, KM. Reduction of nasal fractures under local anaesthetic. Rhinology 2001;39:43–6Google ScholarPubMed
21 Ridder, GJ, Boedeker, CC, Fradis, M, Schipper, J. Technique and timing for closed reduction of isolated nasal fractures: a retrospective study. Ear Nose Throat J 2002;81:49–54Google Scholar
22 Kapoor, PK, Richards, S, Dhanasekar, G, Kumar, BN. Management of nasal injuries: a postal questionnaire survey of UK ENT consultants. J Laryngol Otol 2002;116:346–8Google Scholar
23 Wild, DC, El Alami, MA, Conboy, PJ. Reduction of nasal fractures under local anaesthesia: an acceptable practice? Surgeon 2003;1:45–7Google Scholar
24 Rajapakse, Y, Courtney, M, Bialostocki, A, Duncan, G, Morrissey, G. Nasal fractures: a study comparing local and general anaesthesia techniques. Aust N Z J Surg 2003;73:396–9Google Scholar
25 Courtney, MJ, Rajapakse, Y, Duncan, G, Morrissey, G. Nasal fracture manipulation: a comparative study of general and local anaesthesia techniques. Clin Otolaryngol Allied Sci 2003;28:472–5CrossRefGoogle ScholarPubMed
26 Walshe, P, Harney, M, McConn Walsh, R, Walsh, M. Manipulation of nasal bone fractures under local anaesthetic. Ir Med J 2003;96:50–1Google ScholarPubMed
27 Mondin, V, Rinaldo, A, Ferlito, A. Management of nasal bone fractures. Am J Otolaryngol 2005;26:181–5Google Scholar