Oropharyngeal Packing in Nasal Surgery: Effects on Gastric Fullness and Perioperative Safety.

Abstract

Objective: To investigate whether drinking-water-moistened oropharyngeal packing during nasal surgery is associated with ultrasound-assessed gastric fullness and postoperative nausea and vomiting (PONV), compared with no packing.

Methods: This single-center, retrospective before-after cohort study included 118 adults undergoing nasal surgery, following an institutional protocol change on December 1, 2024. Sixty patients received oropharyngeal packing moistened with drinking water, and 58 received no packing. All patients received standardized anaesthesia and PONV prophylaxis with dexamethasone 4 mg IV administered after intubation. Packing was placed before surgery and removed before extubation. PONV and throat-related symptoms were recorded at 30 minutes, 2 hours, and 24 hours postoperatively. Gastric fullness was assessed ultrasonographically by measuring gastric antral cross-sectional area (GCSA) and gastric volume before and after extubation.

Results: At 30 minutes, PONV was more frequent in the no-packing group (58.6% vs. 18.3%, P < 0.001), as was sore throat (41.4% vs. 26.7%, P=0.035). At 2 hours, PONV remained more frequent in the no-packing group (31.0% vs. 13.3%, P=0.026), but there was no difference at 24 hours. GCSA and gastric volume decreased in the packing group but increased in the no-packing group (GCSA: -14.14% vs. 20.86%; gastric volume: -15.67% vs. 22.00%; both P < 0.001). Demographics, surgical variables, dysphagia, hoarseness, and analgesic/rescue antiemetic use were similar.

Conclusion: Drinking-water-moistened oropharyngeal packing was associated with lower postoperative gastric fullness and a lower incidence of early PONV, without increased throat-related symptoms or rescue medication use. These findings indicate associations, not causal effects, and require confirmation in randomized trials.