Local anaesthesia in flexible nasendoscopy. A comparison between cocaine and co-phenylcaine

Abstract

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.

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

“…In that study, it was concluded that only vasoconstriction had a limited effect (0.8 in a 10‐point scale) in reducing overall discomfort. What is striking in all these studies, including our own, are the quite low levels of discomfort associated with flexible nasendoscopy that ranged from 0.3 (7) to 1.2–2.2 (5,6) in a 10‐point scale, explaining thus the very limited efficacy and the need for topical anaesthetic.…”

“…A study by Frosh et al in 1998 compared the discomfort incurred by the use of local lidocaine with the use of placebo or no spray prior to nasendoscopy and concluded that lidocaine was associated with significantly more pain and overall discomfort than placebo or no spray (4). The effects of cophenylcaine and cocaine on nasal patency (measured through nasal inspiratory peak flow) and pain were compared in another study (5). This showed increased vasoconstrictive effect of cophenylcaine as compared with cocaine but equal local anaesthetic potency.…”

Topical anaesthesia before nasendoscopy: a randomized controlled trial of co‐phenylcaine compared with lignocaine

“…Because of the sensitivity of the nasal mucosa it is common practice for this procedure to be performed after the application of topical anaesthesia. Several studies have compared the efficacy of different topical agents used during outpatient nasendoscopy performed with either rigid or flexible nasendoscopes 1–3 . These studies have not found any difference between the efficacy of cocaine, lignocaine and co‐phenylcaine (lignocaine 5% and phenylephrine 0.5% in combination) regarding either the discomfort experienced by the patient or the ease of obtaining an adequate view.…”

Co-phenylcaine as an alternative to Brompton's solution in rigid nasendoscopy: a pilot study

“…It consists of 5% lignocaine hydrochloride and 0·5% phenylephrine. Cocaine, however, is expensive, is a controlled drug and although safe, is not as safe as co‐phenylcaine (1–3). Severe adverse reactions and even deaths have been reported as a consequence of its application to the nasal cavity (2).…”