***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: To ascertain whether local anaesthetic use is of clinical benefit in nasal surgery , a prospect i ve double-blind r and omized controlled trial of topical bupivacaine on post-operative pain in patients packed after bilateral nasal surgery was carried out . Each patient received a bupivacaine-soaked and a saline-soaked Merocel pack , thereby acting as their own control . Power analysis ascertained the number of patients required to enter the trial to detect a statistically significant difference in pain . Fifty-seven patients completed the trial .  Visual analogue scales determined the level of post-operative pain at different time points in each nostril . Less pain was demonstrated in nostrils containing bupivacaine-soaked packs compared with saline-soaked packs at two hours ( p < 0.0001 ) , four hours ( p = 0.0183 ) and six hours ( p = 0.0476 ) post-operatively . Although not statistically significant , less pain was noted on pack removal on the local anaesthetic sides . These results provide clinical -based evidence for the use of bupivacaine as a local anaesthetic in reducing pain following nasal surgery with packing Packing of the nasal cavity remains a common routine pre caution ary measure following  septal surgery .  The nasal pack and its removal 24 h later are often cited by patients as the most painful aspects of septal surgery .  We present the results of a r and omized , prospect i ve controlled trial of the use of topical 5 % lignocaine ointment as a method of pain relief following post-operative nasal packing .  Post-operative pain as measured using a visual analogue scale at 3 h post-operatively was halved in patients receiving a lignocaine impregnated nasal pack compared with those having a st and ard vaseline gauze pack ( P < 0.05 ) . Pain scores at 6 h post-operatively and at pack removal were also reduced , but these failed to reach significance . No patients suffered reactionary haemorrhage . The use of topical lignocaine ointment is safe and may have a place in the relief of pain due to post-operative nasal packing Background Septorhinoplasty is a traumatic procedure that is associated with epistaxis and postoperative pain . The primary objective of this r and omized double-blind controlled trial was to determine whether intranasal 5 % lidocaine plus naphazoline decreases postoperative pain and lessens the use of rescue analgesics . Methods After induction of general anesthesia and laryngeal topical anesthesia with 5 % lidocaine , 28 adult patients , scheduled to undergo septorhinoplasty , were r and omly assigned to one of two groups , either topical intranasal saline 20 ml ( control group ) or intranasal 5 % lidocaine plus naphazoline solution 0.2 mg ml−1 ( lidocaine group ) . The perioperative dose of sufentanil , the mean end-tidal concentration of isoflurane , and surgeon satisfaction with the operative field were recorded . In the lidocaine group , plasma lidocaine concentrations were sample d 15 , 20 , 25 , 35 , 45 , and 55 min after induction of anesthesia . Visual analogue scale pain scores were recorded 30 , 60 , 90 , and 120 min after the patients arrived in the postanesthesia care unit and 24 h after surgery . Consumption of morphine rescue analgesia and the occurrence of any side effects were recorded at the end of the 24-h study period . Results The intranasal lidocaine-naphazoline application decreased isoflurane requirements [ median values : 0.8 % ( 0.7–1.5 ) vs. 1.2 % ( 0.9–1.8 ) , respectively ; P = 0.04 ] and enhanced surgical conditions . Patients in the lidocaine group experienced less postoperative pain than the control group [ 1 h after surgery : median values of visual analogue scale : 0 ( 0–20 ) vs. 50 ( 30–80 ) , respectively ; P = 0.001 ] , and they required fewer doses of subcutaneous morphine . Total plasma concentrations of lidocaine remained below 4 μg ml−1 throughout the study period . Conclusions Intranasal lidocaine plus naphazoline is a simple and efficient technique for decreasing intra- and postoperative pain and for lessening rescue analgesic requirements in the postoperative period after septorhinoplasty . Toxic plasma concentrations of lidocaine were not reached . Résumé Context eLa rhinoseptoplastie est une procédure traumatisante associée à une épistaxis et des douleurs postopératoires . L’objectif primaire de cette étude r and omisée contrôlée à double insu était de déterminer si une solution intranasale de lidocaïne 5 % plus naphazoline réduisait la douleur postopératoire et diminuait l’utilisation d’analgésiques de sauvetage . MéthodeAprèsl’induction de l’anesthésie générale et une anesthésie laryngée topique avec de la lidocaïne 5 % , 28 patients adultes subissant une rhinoseptoplastie ont été r and omisés en deux groupes : 20 mL de solution saline intranasale topique ( groupe témoin ) ou solution de 5 % lidocaïne intranasale plus naphazoline 0,2 mg·mL−1 ( groupe lidocaïne ) . La dose périopératoire de sufentanil , la concentration d’isoflurane moyenne télo-expiratoire et la satisfaction du chirurgien quant au champ opératoire ont été enregistrés . Dans le groupe lidocaïne , les concentrations plasmatiques de lidocaïne ont été échantillonnées à 15 , 20 , 25 , 35 , 45 et 55 min aprèsl’induction de l’anesthésie . Les scores de douleur sur une échelle visuelle analogique ont été enregistrés 30 , 60 , 90 et 120 minutes aprèsl’arrivée des patients dans l’unité de soins postanesthésiques et 24 h après la chirurgie . La consommation de morphine en analgésie de sauvetage et la survenue d’effets secondaires ont été enregistrées à la fin de la période d’étude de 24 heures . RésultatsL’application de lidocaïne-naphazoline intranasale a diminué les besoins en isoflurane [ valeurs médianes : 0,8 % ( 0,7–1,5 ) vs 1,2 % ( 0,9–1,8 ) , respectivement ; P = 0,04 ] et amélioré les conditions chirurgicales . Les patients du groupe lidocaïne ont souffert de moins de douleurs postopératoires que ceux du groupe témoin [ une heure après la chirurgie : valeurs médianes sur l’échelle visuelle analogique : 0 ( 0–20 ) vs 50 ( 30–80 ) , respectivement ; P = 0,001 ] , et ont nécessité moins de doses de morphine sous-cutanée . Les concentrations plasmatiques totales de lidocaïne sont demeurées au dessous de 4 μg·mL−1 tout au long de la période d’étude . Conclusion La lidocaïne intranasale plus naphazoline est une technique simple et efficace pour diminuer la douleur per- et postopératoire et pour réduire les besoins en analgésiques de sauvetage durant la période postopératoire suivant une rhinoseptoplastie . Un niveau toxique de concentrations plasmatiques de lidocaïne n’a pas été atteint A double-blind investigation has been carried out using three different doses ( 20 , 35 and 50 mg ) of cocaine which were sprayed onto the nasal mucous membranes of forty-five patients for nasal surgery . The cocaine was administered after induction of general anaesthesia in all cases . The 20 mg dose of cocaine dissolved in 2 ml of saline without adrenaline was found to be safe and produced adequate nasal decongestion in the absence of other predominant factors . The efficacy of cocaine and its safety with regard to systemic absorption are assessed We aim ed to investigate the effects of local anesthetics soaked in Merocel nasal packs on  hemorrhage and pain after septoplasty . The methodology includes a prospect i ve double-blind study that was conducted in patients undergoing septoplasty because of nasal septal deviation . The study included 143 patients . The patients were divided into four groups . Each group received 1 % lidocaine + 0.000625 % adrenalin , 0.375 % ropivacaine , 0.25 % bupivacaine as study groups or 0.9 % sodium chloride as a control group in their Merocel packs postoperatively . The local anesthetics or sodium chloride were reapplied at the eighth postoperative hour . Each patient was given a question naire where verbal analog score and amount of postoperative hemorrhage was noted . The statistical analysis was performed using two sided t test on each patient group at each time point . The results included the patients in the control group needing rescue drug most often . There was no statistically significant difference between bupivacaine and lidocaine plus adrenalin in the patients who requested rescue drug . The patients in the ropivacaine group requested rescue drug more frequently than the bupivacaine and lidocaine plus adrenalin groups . Bupivacaine group had significantly better pain scores versus control group at all intervals except for the first postoperative hour . The bupivacaine group had better pain scores versus ropivacaine and lidocaine plus adrenalin groups in the 4th , 8th and the 24th hours . The bupivacaine group had better pain scores versus lidocaine plus adrenalin in the 12th , 16th and the 20th hours . The ropivacaine group had significantly better pain scores versus control group in the 8th , 12th , 16th , 20th and 24th postoperative hours . The ropivacaine group scored better than lidocaine plus adrenalin group just in the 16th hour . The lidocaine plus adrenalin group had significantly better pain scores versus control group in 4th and 12th hours . There was no statistically significant difference between the study groups in terms of postoperative hemorrhage . We concluded that bupivacaine use in nasal surgery provides better analgesia at least in the first 8 h period and does not cause more bleeding . Topical bupivacaine application to nasal packs should be considered after septoplasty OBJECTIVES To compare the efficacy of Spiggle and Merocel foam packs following routine nasal surgery . DESIGN Prospect i ve , r and omised , single-blind , paired study . PARTICIPANTS Twenty adult patients undergoing elective nasal surgery . INTERVENTION At the end of nasal surgery patients were r and omised to have a Spiggle pack inserted in one nasal cavity and a Merocel pack in the other . Packs were removed the following morning . MAIN OUTCOME MEASURES The primary outcome measure was pain due to the presence of packs in the nose and pain associated with their removal . This was measured using a visual analogue scale . Secondary outcome measures were bleeding , crusting and adhesion formation . RESULTS Both packs were effective at preventing postoperative haemorrhage . Bleeding following removal was minimal . There were no significant differences between the packs in terms of levels of discomfort experienced 6 hours after surgery or the following morning prior to removal ( p = 0.3 and p = 0.3 respectively ) . However , the Spiggle foam pack caused significantly less pain on removal compared with the Merocel foam pack ( mean difference 1.4 ; 95 % CI 0.4 to 2.4 , p = 0.005 ) . There were no significant differences in terms of crust and adhesion formation . CONCLUSIONS In this study , both the Spiggle and Merocel foam nasal packs were well tolerated while in the nose . Both provided good postoperative haemostasis and were not associated with bleeding on removal . The Spiggle foam pack had the advantage of causing significantly less pain on removal . However , it must be borne in mind that in this study the Spiggle pack was more likely to be positioned in the non-incised nasal cavity , the side that would generally be expected to be associated with less pain BACKGROUND To maintain a high st and ard of patient care , it is essential to provide adequate pain management in patients who undergo nasal surgery .  Levobupivacaine and ropivacaine are relatively new long-acting local anesthetics . OBJECTIVE The aim of this study was to compare the analgesic effect and blood loss of preincisional levobupivacaine HCl 0.25 % and ropivacaine HCl 0.375 % in patients undergoing septorhinoplasty . METHODS Sixty American Society of Anesthesiologists ( ASA ) I and II patients ( 18 - 55 years old ) who were scheduled for elective open technique septorhinoplasty under general anesthesia  were recruited for this study . The anesthetic technique was st and ardized for both groups . Preoperative and postoperative hemoglobin levels were recorded for all patients . Patients were assigned r and omly to 1 of 2 study groups , and preincisional surgical field infiltration with 5 mL of 0.5 % levobupivacaine plus 5 mL of 0.9 % saline ( group L ; n = 30 ) or 5 mL of 0.75 % ropivacaine plus 5 mL of 0.9 % saline ( group R ; n = 30 ) was performed by the same surgeon . The degree of pain was measured by visual analogue scale ( VAS ) for pain and recorded at multiple time points in all patients after surg 
    Output:
    
AUTHORS ' CONCLUSIONS The addition of local anaesthesia to nasal packs ( if these are being used ) following septal surgery may reduce postoperative pain within the first 12 hours , compared to nasal packing with a placebo added .
Evidence was lacking for other outcomes , including adverse effects .
There is a lack of evidence about the effects of local anaesthesia added to nasal packing compared to no nasal packing .
There is also a lack of evidence about the effects of local anaesthesia given by injection and the effects of sphenopalatine ganglion block