Local anaesthesia in flexible nasendoscopy. A comparison between cocaine and co-phenylcaine. The efficacy of topical anaesthesia in flexible nasendoscopy: a double-blind randomised controlled trial. Cophenylcaine spray vs. placebo in flexible nasendoscopy: a prospective double-blind randomised controlled trial. Flexible transnasal endoscopy: is local anaesthetic necessary? The use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo. A comparison of cocaine and 'co-phenylcaine' local anaesthesia in flexible nasendoscopy. Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy? A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy.
Flexible nasendoscopy is now an integral part of the diagnostic process in Otorhinolaryngology. Topical local anaesthesia is generally recommended and cocaine is usually the drug of choice in view of its concurrent vasoconstrictor action. However, it is expensive, a controlled drug and serious side effects have been reported. Co-phenylcaine forte is a new preparation which also has both local anaesthetic and vasoconstrictor properties. This study compares the efficacy of cocaine and Co-phenylcaine in flexible nasendoscopy and concludes that they provide similar local anaesthesia and vasoconstriction of the nasal mucosa. Co-phenylcaine forte can therefore be used as an alternative to cocaine in flexible nasendoscopy. The routine use of topical anaesthesia during flexible nasendoscopy has been questioned, and the degree to which topical vasoconstrictors can affect patient discomfort has yet to be elucidated. Patients' experiences with Lignocaineand phenylephrine, Lignocaine alone, xylometazoline and no preparation were compared. One hundred patients were recruited in this double-blind, randomised control trial and put into these four groups. Each patient completed a visual analogue scoring chart to determine the severity of unpleasantness and other undesirable effects (pain, bad taste, burning, choking, numbness and difficulty in swallowing). The results confirmed that vasoconstriction is a major contributing factor towards reducing overall unpleasantness (P = 0.022), topical anaesthesia can produce a bad taste (P = 0.022), and that none of the preparations have any effect on the pain during nasendoscopy. In conclusion, xylometazoline is recommended for nasendoscopy as it is effective and is significantly cheaper than the other preparations. Not using any preparations leads to the experience of severe symptoms. Practices vary across the UK on the use of topical preparation prior to flexible fibreoptic nasendoscopy. In this double-blind study, we randomised 98 patients to receive cophenylcaine or placebo nasal spray before flexible nasendoscopy. A visual analogue scale (1-100) was used to record pain, unpleasantness of taste and overall discomfort experienced. Overall, the procedure was associated with minimal pain and discomfort in both groups. There was no significant difference in pain or overall discomfort experienced between the two groups; however, the sensation of bad taste was significantly worse in the cophenylcaine group. In linear regression, factors that predicted the overall unpleasantness of the experience were primarily pain experienced and secondarily unpleasantness of taste. We conclude that the routine use of cophenylcaine for nasal preparation is not justified before flexible nasendoscopy. Prior to flexible transnasal endoscopy (FTE) topical intranasal agents such as cocaine or combinations of a local anaesthetic and vasoconstrictor agent are generally recommended for local anaesthesia, easier access, and better examination of the interior of the nose, especially the middle meatus. This double-blind study involved 60 patients. Each had five per cent cocaine sprayed in one nostril and normal saline in the other. The pain/discomfort and gag scores showed no statistical difference. Forty-two (70 per cent) patients had a moderate/marked deviation of the nasal septum. A significant pain score (3-5) was obtained in 33.3 per cent of cases with the deviation towards the cocaine side and in 37 per cent of cases with the deviation towards the saline side. Ease of procedure scores for both sides were also comparable, when deviation of the nasal septum was taken into account. The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. Each participant was randomized to one of three groups. Group 1 received cophenylcaine spray, group 2 received a placebo spray, and group 3 received no nasal preparation. Flexible nasendoscopy was carried out via a stated protocol and the patient's diagnosis and findings were discussed in the usual way. After the consultation, the patient filled in a questionnaire marking answers on a visual analogue scale. The main outcome measures were pain and overall unpleasantness of procedure. Patient anxiety and willingness to be examined again in the same way if necessary were also assessed. Ease of examination and quality of view were asked from the operator's perspective. The mean scores on a visual analogue scale showed the main outcome measures to be as follows. Pain score measured 1.7 for cophenylcaine, 2.1 for no spray and 2.2 for placebo. Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation. Cocaine is widely used as a local anaesthetic in the nose. However, it is potentially toxic, a known drug of addiction, and its spray delivery devices can theoretically transfer infection. This two-part study investigates a less toxic alternative, 5% lidocaine and 0.5% phenylephrine ('co-phenylcaine') solution, presented in a disposable spray. In the first part, the efficacy of co-phenylcaine was assessed in 25 healthy volunteers. Serial acoustic rhinometry showed a significant, sustained nasal decongestion after co-phenylcaine administration. Visual analogue scale (VAS) scores in response to a painful nasal stimulus confirmed a significant anaesthetic effect. In the second part, co-phenylcaine was compared with 10% cocaine spray in a randomized double-blind trial in 74 patients undergoing out-patient transnasal fibrescopic laryngoscopy. VAS pain ratings and nasal inspiratory peak flow recordings showed no difference between the two solutions. No adverse effects were noted. It is concluded that co-phenylcaine is an excellent alternative to cocaine nasal spray. Although the application of a topical local anaesthetic before fibreoptic nasendoscopy is routine practice in many otolaryngological outpatients, the actual benefit to the patient of this procedure remains in doubt. Eighty-two patients were recruited in this double-blind randomized control trial which compared the patients' experiences of fibreoptic nasendoscopy with nasal preparations of Xylocaine (lidocaine), normal saline, and no spray to the nose and throat. A visual analogue scoring system was used to determine scores for the overall unpleasantness of procedure, receiving a spray, and taste of the spray, and pain. This study has shown significantly worse overall experience (P = 0.001) and pain (P = 0.048) scores for Xylocaine spray versus no spray. It is concluded that the routine use of topical local anaesthetics within the nose before routine fibreoptic nasendoscopy is not only of no value, but actually makes the experience worse for the patient. The purpose of the present study was to compare patient comfort levels following administration of a topical anesthetic, vasoconstrictor, placebo, or nothing to the nasal mucosa prior to flexible fiberoptic transnasal endoscopy. Using a prospective, double-blind, randomized design, 152 consecutive patients were randomly assigned to receive a topical anesthetic (N = 54), vasoconstrictor (N = 50), or placebo (N = 48). No significant differences were found among the three variables. An additional 50 consecutive patients had endoscopy performed without administration of any substance to the nares, and no significant differences were found among the four variables (N = 202). It was concluded that speech-language pathologists can perform independent and comfortable transnasal endoscopy without administration of any substance to the nasal mucosa. Flexible fiberoptic endoscopy, however, should be performed by experienced clinicians with care taken to examine visually the patency of both nares for ease and comfort of scope insertion.
The included studies do not demonstrate any evidence to support the use of topical treatments prior to the use of a fibre-optic nasal endoscope. Some go as far as to suggest that these agents should not be used due to cost and unpleasant side effects. Five studies did not demonstrate any advantage in terms of reducing pain or discomfort when using a topical treatment prior to endoscopy. The absence of demonstrable effect may be due to relatively small patient groups. It is therefore possible that there is a small effect of using these sprays. Further research using standardised reporting methods is needed.