abscess packing after I & D?

28 Oct

2013 Peds Surg article:

N = 85, (43 packing, 42 non-packing)

excluded: diabetic/immunosuppressed, perianal or pilonidal, post-op abscess

everyone got I&D, 7 days oral abx (puts a damper on this data, a bit) warm soaks

two groups were not statistically different with respect to

  • recurrent abscesses (one in each group),
  • MRSA incidence (81.4% PG/85.7% NPG)

 

FROM AN OLD POST:

–prospective, randomized, single-blinded trial, N =48

  • no significant difference in need for a second intervention at the 48-hour follow-up
    • packed (4 of 23 subjects)
    • nonpacked (5 of 25 subjects)
    • (p = 0.72 (NOT SO GOOD))
  • higher pain scores immediately postprocedure in packed group and at 48 hours postprocedure
  • greater use of ibuprofen and oxycodone/acetaminophen in packed group 

 

PERIANAL ABSCESSES:
–“designed to show that perianal abscess may be safely treated by incision and drainage alone” vs. I&D + packing
–50 patients were recruited (7 lost to follow-up); 20 in the packing and 23 in the nonpacking arm

  • Mean healing times were similar ( P = 0.214).
  • The rate of abscess recurrence was similar ( P = 0.61).
  • Postoperative fistula rates were similar ( P = 0.38).
  • Pain scores at the first dressing change were similar ( P = 0.296).
  • Although pain scores appeared much reduced in the nonpacking arm, this did not attain statistical significance

 

BOTTOM LINE:

limited data out there on packing abscesses
–packing doesn’t seem to improve healing or reduce recurrence in limited studies, some with Abx
–packing might hurt more
might be ok NOT to pack abscess after I&D, but limited size studies limit the statistical significance.  small data is suggestive, though.

 

Reference(s): peds surg article;   ; previous post on abscess packing; picture

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