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.

The study objectives were to review the cautery-associated complications of pediatric adenoidectomy, determine the temperature transferred to the prevertebral fascia during adenoid electrocautery and to determine the incidence of neck pain associated with electrocautery during adenoidectomy.Methods: Three consecutive studies were performed: a retrospective review, a cadaver study, and a prospective clinical trial. A retrospective study of 1206 children was performed analyzing adenoidectomy complications over 5 years. A fresh cadaver study was performed involving 18 adenoidectomies to determine the temperature of the prevertebral fascia from electrocautery (30 watts over a 30-second period). A prospective human study was performed involving 200 children who underwent adenoidectomy. Adenoidectomy technique and wattage and duration of electrocautery were recorded for each child. Patients with significant neck pain were evaluated clinically and with MRI.Results: The retrospective study revealed 6 adenoidectomy complications: significant neck pain (3), Grisel's syndrome (1), prolonged velopharyngeal insufficiency (1), and severe nasopharyngeal stenosis (1). The cadaver study revealed a mean peak thermistor temperature of 74.0°C. In the prospective pediatric study, there were 13 patients with neck pain (6.5%), 2 with prolonged painful torticollis requiring MRI evaluation (1%). MRIs revealed tissue swelling without abscess. Symptoms resolved with antibiotics and anti-inflammatory medications. There were no trends associating adenoidectomy technique, cautery power, or cautery duration to the incidence of postoperative neck pain.Conclusions: This is the first study to critically evaluate the use of electrocautery in adenoidectomy. The incidence of complications associated with adenoidectomy is low. The incidence of serious neck pain associated with electrocautery is uncommon.