A comparison of cocaine and 'co-phenylcaine' local anaesthesia in flexible nasendoscopy

Abstract

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.

Phenylephrine as an alternative to cocaine for nasal vasoconstriction before nasal surgery: A randomised trial

“…They found no differences in the Visual Analog Scale pain scores, nasal inspiratory peak flow recordings and incidence of adverse effects in the two groups. [17]…”

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.…”

Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia

“…[9][10][11] In an eclamptic patient, a single report of nasal preparation with a lidocaine-phenylephrine mix (4% lidocaine 3 mL + phenylephrine 0.5 mL + saline 0.5 mL) and intubation described unchanged maternal blood pressures (systolic 150-160 mmHg and diastolic 95-100 mmHg) before and after intubation, and no epistaxis in spite of thrombocytopenia. 12 The venous sinuses of the nose are capable of significant engorgement during pregnancy.…”