A double‐blind randomised controlled trial assessing the efficacy of topical lidocaine in extended flexible endoscopic nasal examinations

Bonaparte, James P.; Javidnia, Hedyeh; Kilty, Shaun

doi:10.1111/j.1749-4486.2011.02403.x

Cited by 18 publications

(27 citation statements)

References 16 publications

(58 reference statements)

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“…Similarly, TNA did not improve participant comfort ratings, which indicates that the amount and concentration used in this study was not entirely effective in numbing the nares against the feeling of the endoscope. Pain/comfort ratings for previous investigations on nasal anesthesia range from 5 to 40 for the TNA condition and from 8 to 57 for the placebo/no treatment condition [20, 27, 29, 32, 33]. With means of 48 and 49.47, respectively, the comfort rating means reported in this study are comparable to previous comfort rating means, if not slightly on the higher end.…”

Section: Discussionsupporting

confidence: 62%

“…Ten studies that assessed nasendoscopic pain treatment included a control treatment (saline or no treatment) and were therefore able to address efficacy [19, 20, 27–34]. Of these ten studies that focused on the efficacy of prenasendoscopic treatment for patient comfort, one recommended using a vasoconstrictor alone instead of TNA, three recommended using TNA, and five recommended using no treatment.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST)

et al. 2013

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Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. The purpose of this double-blind, randomized, controlled, crossover clinical trial was to determine how gel TNA during flexible endoscopic evaluation of swallowing with sensory testing affects sensation, swallowing, and comfort rating scores in healthy nondysphagic participants. Laryngopharyngeal sensory thresholds and swallowing durations were compared between two conditions: TNA and sham. Transition duration decreased statistically significantly during the TNA condition compared to the sham for 10 ml only (p < 0.05). All other swallowing measures did not change between the conditions. Laryngopharyngeal sensory thresholds and perceptions did not change between conditions. No change was observed for subject comfort scores, ease of exam, or quality of view. Future studies should evaluate TNA administration variables, including concentration, dosage amount, and method of application, to determine the optimal strategy for providing comfort while avoiding altered swallowing.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST)

et al. 2013

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“…Interestingly, even though lidocaine is an anesthetic, it does not reduce pain during endoscopy [5,11,19,20]. In this study, we showed that pain scores were similar between lidocaine and placebo.…”

Section: Discussionmentioning

confidence: 48%

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

Şahin¹,

Kökoğlu²,

Güleç³

et al. 2017

Clin Exp Otorhinolaryngol

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ObjectivesTo identify the optimal pharmacological method of preparing patients for nasal endoscopy.Methods Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded.Results The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically.Conclusion Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

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“…6,9,11 One of these studies, however, used sheaths, which increase the diameter of the endoscope, and also a one-minute interval between the spray and examination, which is insufficient for topical local anaesthesia to reach maximum effect. 11 The only trials that have shown significant reduction in discomfort were the two studies performed by Bonaparte et al 4,5 As both of these also included use of a Listerine ® oral rinse before performing NPL, the improved scores for discomfort could be attributed to the effect of the mouthwash rinse offsetting the overall bad taste of the nasal spray. Local anaesthesia can produce unwanted side effects.…”

Section: Discussionmentioning

confidence: 99%

“…There have also been two recently published randomised controlled trials, which have shown a significant reduction in the discomfort associated with flexible nasal endoscopic examination after using topical lidocaine spray with Listerine ® mouthwash (Johnson & Johnson, New Brunswick, NJ, US). 4,5 Furthermore, our personal experiences indicate that there are still variations in practice within and between ear, nose and throat (ENT) departments across the UK. We therefore conducted a double blind randomised controlled trial to assess whether preparation of the nose prior to NPL is effective.…”

mentioning

confidence: 99%

A randomised controlled trial assessing the efficacy of co-phenylcaine nasal spray in flexible transnasal pharyngolaryngoscopy

Javed

Parmar

Hussain

et al. 2017

annals

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INTRODUCTIONThe aim of this study was to assess whether using co-phenylcaine nasal spray before flexible transnasal pharyngolaryngoscopy results in reduced pain and discomfort during the procedure. METHODS This was a randomised controlled trial. Eighty-four patients were randomised to receive either co-phenylcaine nasal spray or placebo nasal spray before performing transnasal flexible pharyngolaryngoscopy. Patient reported outcome measures included pain, discomfort, unpleasantness and willingness to repeat the procedure while clinician reported outcome measures comprised ease of examination and quality of view obtained during the procedure. RESULTS There was no statistically significant difference in scores for pain, discomfort, unpleasantness and willingness to repeat the procedure between the co-phenylcaine and placebo groups. On the other hand, ease of examination scores were significantly better for the co-phenylcaine group than for the placebo group. CONCLUSIONS The majority of patients do not find flexible pharyngolaryngoscopy unpleasant or painful with or without topical nasal anaesthesia. However, the spray does appear to help the examiner in completing a satisfactory assessment.

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A double‐blind randomised controlled trial assessing the efficacy of topical lidocaine in extended flexible endoscopic nasal examinations

Cited by 18 publications

References 16 publications

Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST)

Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST)

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study

A randomised controlled trial assessing the efficacy of co-phenylcaine nasal spray in flexible transnasal pharyngolaryngoscopy

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