The use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo

Abstract

The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. Each participant was randomized to one of three groups. Group 1 received cophenylcaine spray, group 2 received a placebo spray, and group 3 received no nasal preparation. Flexible nasendoscopy was carried out via a stated protocol and the patient's diagnosis and findings were discussed in the usual way. After the consultation, the patient filled in a questionnaire marking answers on a visual analogue scale. The main outcome measures were pain and overall unpleasantness of procedure. Patient anxiety and willingness to be examined again in the same way if necessary were also assessed. Ease of examination and quality of view were asked from the operator's perspective. The mean scores on a visual analogue scale showed the main outcome measures to be as follows. Pain score measured 1.7 for cophenylcaine, 2.1 for no spray and 2.2 for placebo. Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation.

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.…”

“…Some other studies have also reported on the effect of local anaesthetic nasal spray on ease of examination. 9,12 In our study, a significant difference was seen with the clinician finding the examination easier in patients who received the co-phenylcaine spray. This is at odds with the results of Cain et al, where there was no significant difference in this outcome measures.…”

“…This is at odds with the results of Cain et al, where there was no significant difference in this outcome measures. 9 Singh et al also reported comparable scores in terms of ease of procedure for both the local anaesthetic and the placebo groups. 12 The high scores in our study for ease of examination and quality of view could be due to a combination of a single experienced clinician performing all the examinations and the passage of the scope through the most accommodating nostril.…”

“…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. However, in this trial all patients underwent extended or full bilateral nasal examination, which differs from the pharyngo-laryngeal examination in our study.…”

“…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.…”