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

Abstract

Objective: To evaluate the relative effectiveness of co-phenylcaine (lignocaine 5% with phenylephrine) and lignocaine 5% sprays when administered prior to rigid nasendoscopy. Design: Randomized, double blind controlled study. Setting: Teaching hospital otolaryngology unit. Participants: Thirty patients requiring routine outpatient rigid nasendoscopy were administered five puffs of either co-phenylcaine or lignocaine 5% spray which had been randomly assigned to either the first or the second visit. Ten minutes later nasendoscopy was performed. Immediately after nasendoscopy the ease of performance of the procedure and the quality of the view achieved was rated on a visual analogue scale by the endoscopist and the patients recorded the level of pain experienced on a visual analogue scale. Two weeks later, the patients returned for a repeat nasendoscopy, receiving the alternate spray. Main outcomes measures: Ease of performance and quality of view of achieved by endoscopists and pain experienced by patients, both measured with visual analogue scales. Results: The ease of passage of the endoscope and quality of the view obtained was found to be greater after the administration of co-phenylcaine [visual analogue scores 84 (95% CI: 80–89) than after lignocaine and 77 (95% CI: 73–81) (P < 0.01)]. The two sprays produced similar levels of topical anaesthesia. Conclusions: Nasendoscopy can be performed with minimal discomfort after the administration of either co-phenylcaine or lignocaine 5% sprays. The vasoconstricting action of co-phenylcaine increases the ease of passage of the endoscope and quality of the view obtained by the endoscopist.