Risks of Pharyngeal Pack Use Following FESS Outweigh Benefits

Do pharyngeal packs have an effect on postoperative pain and postoperative nausea and vomiting in functional endoscopic sinus surgery (FESS)?

Bottom line
There was no significant difference in mean throat pain at four hours following surgery or level of nausea at four hours and 24 hours after surgery; the difference in pain levels at 24 hours after surgery may be explained by other phenomena. The authors advise against using the packs due to potential risks.

Background: It is thought that pharyngeal packs prevent cartilage and bony debris aspiration and blood product ingestion during FESS, thereby decreasing the incidence of postoperative nausea and vomiting (PONV). Studies have failed to show this connection adequately, and the pharyngeal packs can increase some complications, including postoperative throat pain and aphthous stomatitis.

Study design: Powered, double-blinded randomized control trial of 46 patients scheduled for routine endoscopic sinus surgery, randomly allocated to pharyngeal packing and control groups.

Setting: Icahn School of Medicine at Mount Sinai, New York City.

Synopsis: The mean and median throat pain at four hours following surgery were 1.73 and 0.0, respectively. There were no significant differences in the mean throat pain across either group at four hours following surgery. The mean and median throat pain at 24 hours following surgery were 1.12 and 0.0, respectively. However, patients without pharyngeal packing experienced more pain than those who had a throat pack placed, with a mean difference of 1.5. Of the 45 patients who were captured with the four-hour nausea and vomiting survey, 39 denied any nausea, while three, two, and one complained of mild, moderate, and severe nausea, respectively. Pharyngeal packing presence or absence did not appear to influence the level of nausea experienced within four hours of surgery. Only four patients, three receiving pharyngeal packs and one in the control group, reported one or more vomiting episodes at any point within 24 hours of their surgery. Limitations included the fact that no record was kept of the amount of narcotics used by patients postoperatively or whether the throat was suctioned with an orogastric tube.

Citation: Green R, Konuthula N, Sobrero M, et al. Use of pharyngeal packs in functional endoscopic sinus surgery: a randomized controlled trial. Laryngoscope. 2017;127: 2460–2465.