Xylometazoline 0.1% nasal drops

AbstractBackgroundNasotracheal intubation is associated with a risk of epistaxis. Several drugs, including cocaine and xylometazoline may be used as decongestants prior to nasotracheal intubation to prevent this. We hypothesized that xylometazoline would prevent epistaxis more effectively than cocaine, demonstrated by a lower proportion of patients with bleeding after nasotracheal intubation.MethodsWe conducted a single‐center, outcome assessor and analyst‐blinded, clinical randomized controlled trial following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. Patients scheduled for surgery under general anesthesia with nasotracheal intubation were randomized to receive either 2 mL 4% cocaine or 2 mL 0.05% xylometazoline prior to nasotracheal intubation. Immediately following intubation, epistaxis was evaluated by the blinded intubating anesthetist on a four‐point scale. We measured heart rate and blood pressure the first 5 min after drug administration. Adverse events were followed up after 24 h.ResultsA total of 53 patients received cocaine and 49 patients received xylometazoline. Bleeding occurred in 32 patients receiving cocaine (60.4%) and in 34 patients receiving xylometazoline (69.4%) (p = .41, Fisher's exact test) with a difference of 9.0% (95% CI: −9.4% to 27%). There was no statistically significant difference between groups regarding the heart rate or blood pressure. No adverse cardiac events were recorded in either group.ConclusionWe found no statistically significant difference between cocaine and xylometazoline in preventing epistaxis after nasotracheal intubation, and the choice of vasoconstrictor should be based on other considerations, such as pricing, availability and medicolegal issues.

Abstract licence: CC BY 4.0

Objective:This study evaluated the efficacy of 0.1% xylometazoline-hydrochloride nasal decongestant spray compared to 0.9% saline nasal spray in relieving post-septoplasty clinical nasal findings and symptoms. Methods: This triple-blinded randomized-clinical-trial was conducted in 2 tertiary-care hospitals in Karachi-Pakistan. A total of 120 septoplasty patients were recruited from June 20, 2022, to June 20, 2023. Randomly equally-assigned participants received either 0.9% isotonic-saline (control group) or 0.1% xylometazoline-hydrochloride (intervention group) nasal sprays. Participants were instructed to use nasal sprays for 1 week, twice daily, with a 12 hour interval between the 2 doses as a single spray per nostril. Follow-up assessments were conducted on days 3 and 7 after surgery. Postoperative symptoms, nasal-endoscopic findings, adverse-effects, and patient satisfaction were compared using Chi-square test and a P value of <.05 was considered significant. Results: Of 120 participants, 106 were analyzed with 53 participants in each group. By the end of third postoperative day, intervention group exhibited significantly lower rates of self-reported symptoms, including bleeding (7.5%:54.7%), nasal obstruction (3.8%:45.3%), headache (1.9%:30.2%), pain (3.8%:7.5%), as well as clinical nasal findings, including nasal edema (1.9%:58.5%), crusting (11.3%:58.5%), nasal discharge (9.4%:22.6%), and nonhealed scarring (18.9%:58.5%), compared to control group ( P value < .001). On the seventh day, intervention group exhibited absence of self-reported symptoms and clinical nasal findings, whereas control group still experienced moderate symptoms ( P value < .001). Intervention group had significantly higher patient satisfaction ( P value < .001). Conclusions: Xylometazoline spray is highly effective in relieving post-septoplasty clinical nasal findings and symptoms, without adverse effects, indicating potential for wider clinical utilization. Trial Registration: UMIN Clinical-trial-registry: UMIN000052217. ( https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000059598 ).

Abstract licence: CC BY-NC 4.0

Background: Epistaxis is a frequent emergency room presentation, with a significant portion of cases requiring active medical intervention. While anterior nasal packing remains a conventional approach, newer pharmacological options like topical tranexamic acid (TXA) have gained attention due to their antifibrinolytic action. Xylometazoline, a topical decongestant with vasoconstrictive properties, is commonly used in emergency settings for anterior epistaxis, yet comparative data between the two agents remain limited. Objective: To compare the efficacy of topical application of intravenous TXA with topical xylometazoline in achieving hemostasis in patients presenting with anterior epistaxis who are on antiplatelet therapy. Methods: This prospective randomized controlled trial was conducted at the Emergency Department of the Pakistan Institute of Medical Sciences, Islamabad, from December 2023 to November 2024. A total of 88 patients, aged 13–60 years, using antiplatelet medications and presenting with anterior epistaxis were enrolled. Patients were randomized into two groups (n=44 each). Group A received 100 mg/mL of intravenous TXA applied topically via nasal spray. Group B received 2–3 puffs of 0.1% xylometazoline spray in each nostril. Hemostasis was assessed at 30 minutes post-administration. SPSS version 25.0 was used for statistical analysis, and chi-square test determined significance at p<0.05. Results: The mean age was 47.3 ± 7.4 years in Group A and 45.3 ± 8.6 years in Group B (p=0.846). Group A comprised 26 males (59%) and 18 females (41%), while Group B had 28 males (63.63%) and 16 females (36.36%) (p=0.568). Hemostasis at 30 minutes was achieved in 10 patients (22.73%) in Group A and 29 patients (65.91%) in Group B, showing a statistically significant difference (p<0.001). Conclusion: Topical xylometazoline demonstrated significantly higher efficacy compared to intravenous TXA preparation in achieving hemostasis for anterior epistaxis in patients on antiplatelet therapy, supporting its role as a first-line intervention in emergency care.

Abstract licence: CC BY-NC-ND 4.0

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

Background The most frequent complication of nasotracheal intubation (NTI) is epistaxis. Epinephrine nasal gauze packing has been used conventionally as a pre-treatment for reducing epistaxis, but it carries a disadvantage of pain and anxiety in patients. However, xylometazoline drops are easier to administer and more convenient for patients. We aimed at comparing the effectiveness of xylometazoline drops and epinephrine merocele packing in reducing bleeding and postoperative complications in our population. Methods Our study enrolled 120 patients in a double-blind randomized controlled trial. We randomly allocated ASA1 or 2 adult patients into 2 groups: Group X and Group E. Group X received 0.1% xylometazoline nasal drops, and epinephrine (1:10,000) merocele nasal packing was used in Group E. The primary outcome was the incidence of bleeding during NTI; the severity of bleeding, navigability, bleeding during extubation, and postoperative complications were secondary outcomes. We used IBM SPSS and Minitab software for statistical analysis, and P < 0.05 was considered statistically significant. Results We analyzed the data of 110 patients: 55 in Group X and 55 in Group E. The two groups did not have different bleeding incidence (56.4% vs 60.0%; P = 0.70); however, the incidence of severe bleeding was less with xylometazoline than with epinephrine (3.63% vs 14.54%; P < 0.05). We also observed less bleeding during extubation (38.2% vs 68.5%; P < 0.05) with xylometazoline. Other secondary outcomes were akin to both groups. Conclusion The incidence of severe and post-extubation bleeding was significantly less with xylometazoline. Hence, it may be an effective alternative for reducing the incidence and severity of epistaxis during NTI.

Abstract licence: CC BY-NC 4.0

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