Manipulation of the fractured nose: a comparison of local infiltration anaesthesia and topical local anaesthesia.

Reduction of simple nasal fractures under local anaesthetic is now an accepted practice. The anaesthetic is usually administered using an external percutaneous approach, coupled with topical intranasal cocaine. Topical local anaesthetic with intranasal cocaine is an alternative method. Fifty-four adult patients with simple displaced nasal fractures were randomised to three different groups prior to fracture reduction in the outpatient department. Group A received external local infiltration, Group B received topical EMLA cream whilst Group C received topical AMETOP gel. All patients received topical intranasal cocaine. The cosmetic result and airway patency were comparable in all groups. However, patients in group A perceived the procedure as significantly more painful than the patients of groups B and C. Despite the increased procedure time, we recommend topical anaesthesia as the method of choice to reduce simple nasal fractures in the outpatient department. It offers a similar outcome, whilst being significantly less painful than external infiltration.

RCT Entities:   Population Interventions Outcomes