Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy?

Abstract

Although the application of a topical local anaesthetic before fibreoptic nasendoscopy is routine practice in many otolaryngological outpatients, the actual benefit to the patient of this procedure remains in doubt. Eighty-two patients were recruited in this double-blind randomized control trial which compared the patients' experiences of fibreoptic nasendoscopy with nasal preparations of Xylocaine (lidocaine), normal saline, and no spray to the nose and throat. A visual analogue scoring system was used to determine scores for the overall unpleasantness of procedure, receiving a spray, and taste of the spray, and pain. This study has shown significantly worse overall experience (P = 0.001) and pain (P = 0.048) scores for Xylocaine spray versus no spray. It is concluded that the routine use of topical local anaesthetics within the nose before routine fibreoptic nasendoscopy is not only of no value, but actually makes the experience worse for the patient.

Does the Use of Topical Lignocaine Spray during Microlaryngeal Surgery Under General Anaesthesia have Significant Clinical Benefit? - A Prospective Double-Blind Randomized Placebo-Controlled Trial

“…Topical lignocine was associated with a greater degree of postoperative throat discomfort than placebo in the study. Sore throat is in fact a known potential side-effect of topical lignocaine [4]. Frosh et al also found that the routine use of topical lignocaine spray in the nose prior to fibreoptic nasendoscopy makes the experience more painful for the patient [4].…”

“…Sore throat is in fact a known potential side-effect of topical lignocaine [4]. Frosh et al also found that the routine use of topical lignocaine spray in the nose prior to fibreoptic nasendoscopy makes the experience more painful for the patient [4]. It is the low pH of lignocaine solutions that has been found to be responsible for post-operative sore throat [5].…”

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

“…10 Their study, however, used Xylocaine spray (lidocaine), which is commonly observed to cause nasal discomfort. 9 In another trial by Bonaparte et al, pain scores were significantly reduced with local anaesthetic spray in patients with an inflammatory disorder of the nasal cavity compared to those without an inflammatory condition.…”

Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

“…At this time a decision may be made regarding the application of a topical anesthetic and/or vasoconstrictor to the nasal mucosa to make the passage of the scope more comfortable. The effectiveness of topical anesthesia for this purpose is currently unclear with some research indicating a bene fi t and others indicating that application of these solutions do not have the desired effect of making the exam more comfortable [ 7 ] and may even lead to greater discomfort for the patient [ 8 ] . Given the equivocal evidence for the use of topical anesthesia, some clinicians will limit their preparation to administration of a vasoconstrictor and lubrication of the insertion portion of the endoscope [ 9 ] .…”