Management of Epistaxis Comparing Nasal Packing Versus Greater Palatine Foramen Block

NCT07421622 | Not Yet Recruiting DMC

• 1 other identifier: TERC/SC/INT/2026/009
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

The goal of this pilot randomized controlled trial is to compare pain relief efficacy while using nasal packing versus greater palatine foramen block (GPFB) in the management of acute episodes of epistaxis. The main questions it aims to answer are: Does GPFB have less potential to inflict pain when dealing with hemostasis with epistaxis, utilizing a pre-validated 10-point visual analog scale (VAS)? Was hemostasis management more effective in either technique? Researchers will compare anterior nasal packing to greater palatine foramen block using 2% xylocaine with adrenaline. Patients will receive any of the hemostatic interventions at the time of the acute epistaxis episode. The questionnaire will be administered 24 hours post-intervention.

Conditions

Epistaxis Nosebleed; Greater Palatine Foramen

Keywords

epistaxis

Outcome Measures

Primary Outcomes (1)

• ● Pain intensity measured

  using the 10-point Visual Analog Scale (VAS) for the interventions mentioned

  24 hours post intervention

Secondary Outcomes (1)

• ● Successful control of epistaxis

  24 hours post intervention

Study Arms (2)

Anterior Nasal Packing

ACTIVE COMPARATOR

Patients receiving anterior nasal packing for acture epistaxis

Procedure: Anterior Nasal Packing

Greater Palatine Foramen Block (GPFB)

ACTIVE COMPARATOR

Patients receiving GPFB to achive hemostasis in acute epistaxis

Procedure: Greater Palatine Foramen Block with 2% xylocaine with adrenaline

Interventions

Greater Palatine Foramen Block with 2% xylocaine with adrenaline PROCEDURE

Patients allocated to this group will receive a greater palatine foramen block using a local anaesthetic agent (2% i.e. 20mg/dL Inj. Lidocaine with adrenaline) administered at the greater palatine foramen under aseptic conditions. Patients will be monitored for local anaesthetic as well as GPF block-related adverse effects. Hemostasis will be assessed following the procedure.

Also known as: greater palatine foramen block, GPFB

Greater Palatine Foramen Block (GPFB)

Anterior Nasal Packing PROCEDURE

Patients allocated to this group will receive anterior nasal packing using standard non-absorbable nasal packs following institutional protocol. Packs will remain in situ for 24-72 hours, unless earlier removal is clinically indicated.

Also known as: ANP, nasal packing, BIPP packing, merocel

Anterior Nasal Packing

Eligibility Criteria

• Age: 18 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Presentation with active anterior epistaxis
• Failure of initial conservative measures (e.g., nasal compression and topical vasoconstrictors)
• Ability to provide informed consent and those who consent for the study.

You may not qualify if:

• Suspected or confirmed posterior epistaxis
• Known bleeding disorders or platelet count \<50,000/mm³
• Use of anticoagulants with supratherapeutic INR
• Known allergy to local anaesthetic agents

Sponsors & Collaborators

• Sheikh Zayed Federal Postgraduate Medical Institute: lead

Related Publications (10)

• Singh H, Sharma P, Kanotra S, Gupta K, Kotwal S, Gupta D. Role of nasal endoscopy in evaluation and management of epistaxis. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2024;10(2):178-82.

  BACKGROUND

• Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health. 2008 Apr;31(2):180-91. doi: 10.1002/nur.20247.

  PMID: 18183564 BACKGROUND

• Murray S, Mendez A, Hopkins A, El-Hakim H, Jeffery CC, Cote DWJ. Management of Persistent Epistaxis Using Floseal Hemostatic Matrix vs. traditional nasal packing: a prospective randomized control trial. J Otolaryngol Head Neck Surg. 2018 Jan 8;47(1):3. doi: 10.1186/s40463-017-0248-5.

  PMID: 29310703 BACKGROUND

• Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, Lin KW, Lind MM, Poetker DM, Riley CA, Schneider JS, Seidman MD, Vadlamudi V, Valdez TA, Nnacheta LC, Monjur TM. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(1_suppl):S1-S38. doi: 10.1177/0194599819890327.

  PMID: 31910111 BACKGROUND

• Hwang SH, Kim SW, Kim SW, Kim BG, Cho JH, Kang JM. Greater palatine canal injections reduce operative bleeding during endoscopic sinus surgery: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2019 Jan;276(1):3-10. doi: 10.1007/s00405-018-5138-6. Epub 2018 Sep 20.

  PMID: 30238311 BACKGROUND

• Koskinas I, Terzis T, Georgalas C, Chatzikas G, Moireas G, Chrysovergis A, Triaridis S, Constantinidis J, Karkos P. Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society. Eur Arch Otorhinolaryngol. 2024 Apr;281(4):1613-1627. doi: 10.1007/s00405-023-08310-4. Epub 2023 Nov 30.

  PMID: 38032485 BACKGROUND

• Corbridge RJ, Djazaeri B, Hellier WP, Hadley J. A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis. Clin Otolaryngol Allied Sci. 1995 Aug;20(4):305-7. doi: 10.1111/j.1365-2273.1995.tb00047.x.

  PMID: 8548959 BACKGROUND

• Dispenza F, Lorusso F, Di Vincenzo SA, Dolce A, Immordino A, Gallina S, Maniaci A, Lechien JR, Calvo-Henriquez C, Saibene AM, Sireci F. Management of uncontrolled/recurrent epistaxis by ligation or cauterization of the sphenopalatine artery: a scoping review. Eur Arch Otorhinolaryngol. 2024 Dec;281(12):6229-6238. doi: 10.1007/s00405-024-08852-1. Epub 2024 Jul 28.

  PMID: 39069575 BACKGROUND

• Krulewitz NA, Fix ML. Epistaxis. Emerg Med Clin North Am. 2019 Feb;37(1):29-39. doi: 10.1016/j.emc.2018.09.005.

  PMID: 30454778 BACKGROUND

• Abraham ZS, Fussi OC, Kahinga AA. Knowledge and practices of epistaxis in Eastern Tanzania: A cross-sectional study of an emergency in otorhinolaryngology. Afr J Emerg Med. 2024 Jun;14(2):70-74. doi: 10.1016/j.afjem.2024.03.002. Epub 2024 Mar 19.

  PMID: 38545448 BACKGROUND

MeSH Terms

Conditions

Epistaxis

Interventions

Lidocaine; Epinephrine; Atrial Natriuretic Factor; polyvinyl alcohol formaldehyde foam

Condition Hierarchy (Ancestors)

Nose Diseases; Respiratory Tract Diseases; Otorhinolaryngologic Diseases; Hemorrhage; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms, Respiratory; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Acetanilides; Anilides; Amides; Organic Chemicals; Aniline Compounds; Amines; Ethanolamines; Amino Alcohols; Alcohols; Biogenic Monoamines; Biogenic Amines; Catecholamines; Catechols; Phenols; Benzene Derivatives; Hydrocarbons, Aromatic; Hydrocarbons, Cyclic; Hydrocarbons; Natriuretic Peptides; Peptide Hormones; Hormones; Hormones, Hormone Substitutes, and Hormone Antagonists; Peptides; Amino Acids, Peptides, and Proteins

Central Study Contacts

WIZRA FAIZ, MBBS

CONTACT

+92 3219458432; wizrafaiz1999@gmail.com

Sarfraz Latif, MBBS, FCPS, DLO

CONTACT

+92 321 4467702; drsarfrazlatif@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Professor Head of Otolaryngology & Head and Neck Surgery

Study Record Dates

• First Submitted: February 12, 2026
• First Posted: February 19, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): February 28, 2027
• Study Completion (Estimated): February 28, 2027
• Last Updated: February 24, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share