Effect of phenylephrine spray on closed reduction of nasal fractures in patients under general anesthesia

Introduction: As the most anterior part of the face, the nose is more prone to trauma than other parts of the face, thereby making it the most common facial fracture site. Closed reduction has long been used as the standard treatment of the nasal fracture, which can be performed outpatiently or inpatiently. Bleeding due to the fracture can be minimized by adopting certain strategies before the realignment of the nasal fracture. One of these strategies is to use phenylephrine spray before surgery. This study aimed to evaluate the effect of phenylephrine spray in closed reduction of nasal fractures. Methods: A total number of 200 patients with nasal fracture – who were admitted to the ENT department of Vali-e-Asr Hospital in 2014 and 2015 – were incorporated in this clinical trial via simple randomization method. The patients were assigned into case and control groups. The case group received phenylephrine spray twice: 30 minutes before the surgery and before anesthesia. The control group did not receive phenylephrine spray. To evaluate the efficiency of the spray, data concerning intraoperative and postoperative bleeding, pain intensity, blood pressure, and the need for tampon in both groups were recorded. The data were compared in the SPSS software version 18 using T-test and Chi-Square test at a confidence level of 95%. Results: The average age of the participants was 25.12±13.73 years and the majority were men (n=127; 63.5%). The mean systolic pressure of the patients in the case group was significantly higher than that of the patients in the control group (P=0.02). Furthermore, the bleeding volume during surgery in the cases was significantly lower than that of the controls (P=0.01). However, postoperative bleeding volume, pain intensity, and the need for tampon were not significantly different in the groups. Conclusions: By reducing the intraoperative bleeding, phenylephrine spray can play an important role in decreasing the complications caused by surgery. However, it is not recommended for the patients with heart diseases because it increases systolic pressure.