Negative pressure drainage versus nasal packing in patients undergoing septoplasty: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Traditional nasal packing following septoplasty imposes significant patient morbidity, including pain, obligate oral breathing, and sleep disruption. Negative pressure drainage (NPD) represents a mechanistically distinct alternative, but no synthesis of comparative evidence existed prior to this review. Methods A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing NPD with nasal packing following septoplasty was conducted in accordance with PRISMA 2020 (PROSPERO: CRD420261297218). PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov were searched from inception to January 2026. Primary outcome was postoperative pain. Secondary outcomes included nasal obstruction, complications, treatment efficacy, and cost-effectiveness. Risk of bias was assessed using RoB 2. Results Four RCTs comprising 315 patients were included, between 2014 and 2025. Risk of bias was rated as some concern in all the studies. NPD demonstrated a statistically significant reduction in postoperative pain at 24 h (MD = -2.36, 95% CI: -4.10 to -0.62), exceeding the minimum clinically important difference, though substantial heterogeneity was present (I² = 95.2%). NPD was associated with significantly lower nasal obstruction scores in the immediate postoperative period. Adhesion rates trended lower with NPD (2.8% vs. 6.5%; RR = 0.50, 95% CI: 0.14 to 1.83) without reaching significance. Overall treatment effectiveness was comparable between groups (RR = 1.07, 95% CI: 0.99 to 1.16). NPD was associated with substantially lower per-patient costs in one study. Conclusion NPD offers clinically meaningful early postoperative pain and comfort advantages over traditional nasal packing with equivalent efficacy and an acceptable safety profile. The evidence base remains limited to four single-country trials, and adequately powered RCTs are needed before definitive practice recommendations can be made.