Cophenylcaine spray vs. placebo in flexible nasendoscopy: a prospective double-blind randomised controlled trial

Abstract

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.

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

“…7 Our study has shown that using a local anaesthetic/vasoconstrictor nasal spray before performing NPL does not confer any significant benefit in reducing patient pain, discomfort or unpleasantness during the procedure. Similar results have been obtained in other trials comparing local anaesthetic sprays with a placebo spray and/or no nasal preparations 6,8,9 but in most of these studies, other confounding variables were also present, such as the use of lubricant gel and multiple examiners involved in performing the NPL.…”

“…8 In another study by Georgalas et al, unpleasantness of taste was also significantly increased for the co-phenylcaine group. 6 In our study when patients were asked to report on their unpleasantness feeling with the procedure including their experience with the spray itself, there was no significant difference seen between both groups. No patients had any choking or gagging sensations and there were no allergic reactions to the nasal spray.…”

“…Similar to our findings, other trials have shown that using a topical nasal spray does not reduce the severity of discomfort during NPL. 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.…”

Patient‐related and ENT‐related predictive factors based on the pain experienced during flexible nasendoscopy

“…Flexible nasendoscopy is considered to be an unpleasant, painful, and uncomfortable procedure; consequently, many authors have tried different solutions to diminish the patient's discomfort, such as a nasal decongestant, topical nasal anesthesia using a cocaine solution, xylocaine or oxymetazoline, nasal lubricants, or simple saline irrigation . None of those solutions provided a clear advantage or reduced perceived pain, except for some positive experience with topical cocaine .…”

Pain Perception of Children Undergoing Nasendoscopy for Investigation of Voice and Resonance Disorders

“…6 Studies involving adult participants undergoing nasendoscopy demonstrate that this procedure is somewhat uncomfortable and painful. [7][8][9][10][11][12] Several of these studies found that the participants' perception of discomfort was greater when a topical anesthetic was used on the nasal mucosa because of the unpleasant taste, [7][8][9]12 whereas the level of unpleasantness was found to be reduced in patients who received topical nasal vasoconstriction. 12 However, regardless of the type or presence of anesthetic, these studies revealed that adults perceive nasendoscopy as painful, 7,10,11 unpleasant, 7,9 and uncomfortable 8,11 to some degree.…”