Otolaryngologists, facial plastic surgeons, and anesthesiologists rely on local anesthetics to perform many intranasal procedures. With the increased use of functional endoscopic sinus surgery, the number of intranasal procedures using local anesthetics is likely to increase.

     For many years, cocaine was the preferred topical local anesthetic used for intranasal procedures, but a replacement has been sought due to its increasing cost, decreasing availability, toxicity, and habit-forming potential. Few other local anesthetics have been widely used to provide topical nasal anesthesia. Lidocaine and tetracaine are the most commonly chosen alternatives to cocaine, but must be mixed with a vasoconstrictor to provide optimal surgical conditions.

     A study conducted by the University of Texas Health and Science Center, San Antonio, Texas, compared the degree of vasoconstriction and anesthesia obtained with cocaine vs. that obtained with a mixture of lidocaine and oxy,etazoline in healthy male volunteers. Blood flow was evaluated by laser Doppler flowmetry. Anesthesia was measured with Semmes-Weinstein monofilaments, testing both sensation threshold and pain perception. A greater decrease in blood flow was seen after the administration of lido/oxy that after the administration of cocaine. Pain perception was not significantly different between treatment groups at 10 minutes after removal of the medication-soaked pledget, but lido/oxy caused a greater decrease in pain perception than cocaine after 50 minutes. No significant difference in sensation threshold change was seen between treatment groups. The authors concluded that lidocaine with oxymetazoline is believed to an effective alternative to cocaine for intranasal procedures. *

* Anesth Analg 1995;81:724-7