Sodium cromoglicate 2% / Xylometazoline 0.025% nasal spray

Objective: The objective of this study was to compare the efficacy of topical xylometazoline and topical tranexamic acid in achieving bleeding control in patients presenting with anterior epistaxis in the emergency department. Method: After getting approval from the ethical review board, this RCT was conducted at Rawalpindi Teaching Hospital from 2nd February 2024 to 1st February 2025. A total of 80 patients (more than 18 years of age) with spontaneous anterior epistaxis were included in the study using non-probability consecutive sampling. They were randomly assigned to two equal groups (n = 40 each). One group received topical xylometazoline (0.1%), which was put on a cotton pledget and inserted into the affected nostril, while the other group received topical tranexamic acid (500 mg in 5 mL) using the same technique. The pledgets remained in place for 10 minutes. The primary outcome was to note the time to achieve haemostasis, which was categorised into 4 intervals: 5-10 minutes, 11-20 minutes, 21-30 minutes, or more than 30 minutes. If the bleeding had not stopped within 30 minutes, it would mean treatment failure, and the patient would be managed via cautery or nasal packing. The secondary outcome was to note the incidence of rebleeding within 48 hours. Results: In the tranexamic acid group, 45% of patients achieved haemostasis within 5–10 minutes, while only 23% of patients achieved haemostasis in the xylometazoline group in the same period, indicating a statistically significant difference (p = 0.019). An additional 45% of the patients in the tranexamic acid group achieved haemostasis within 11–20 minutes, whereas only 18% in the xylometazoline group stopped bleeding within the same timeframe. In the 21–30-minute category, 15% of the patients treated with tranexamic acid achieved haemostasis compared to 25% in the xylometazoline group. For the secondary outcome of rebleeding within 8 hours,43% of patients in the tranexamic acid group experienced recurrence of bleeding, compared to 50% in the xylometazoline group (p = 0.23). Conclusion: These findings suggest that Topical tranexamic acid is significantly more effective in achieving rapid haemostasis compared to xylometazoline and is associated with a lower failure rate. However, both agents exhibit similar rebleeding rates within 48 hours. Keywords: Epistaxis; Tranexamic acid; Administration, Topical; Hemostasis; Vasoconstrictor agents; Antifibrinolytic agents

Abstract licence: CC BY-SA 4.0

Abstract BACKGROUND: The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. A total of 60 patients were enrolled in the study. Thirty patients were randomized each to lidocaine/Xylometazoline or to control local anesthesia group. Group A participants received 4% Lidocaine and 0.1% Xylometazoline solution as intranasal spray while Group B participants received injectable local anesthesia. Local anesthesia was then assessed and reading was taken on the Visual Analog Scale. If the reading was ‘0’ the cavity preparation was performed. If the VAS reading was more than ‘0’ a third dose of intranasal spray anesthesia was delivered. If profound local anesthesia was still not achieved the case was labeled as failure of intranasal spray anesthesia and local anesthesia was achieved by conventional infiltration anesthesia. For Group B participants, local anesthesia was achieved by means of conventional infiltration anesthesia. SPSS v.16 was used to analyze the data with level of significance set at p0.05). There was a statistically significant effect of ICDAS score on the efficacy of intranasal spray anesthesia (p<0.05). CONCLUSION: Lidocaine xylometazoline intranasal spray solution was fairly efficacious in anesthetizing maxillary teeth with smaller carious lesions for restorative procedures in patients with a stable medical history. Intranasal spray solution can be used for patients with needle phobia.TRIAL REGISTRATION: The study is registered on clinical trials website via NCT04732104 on 26/01/2021.

Abstract licence: CC BY 4.0