The efficacy of 4% lidocaine with 3% ephedrine used on nasal packs or as a nasal spray for pain relief in nasal endoscopy

Background: Before nasal endoscopy, topical intranasal anesthetics and decongestant are usually used to relieve patients’ pain and discomfort. Two methods of drug administration are usually performed, nasal packing vs. nasal spray.

Objective: We compared the efficacy of nasal packing vs. nasal spray with 4% lidocaine and 3% ephedrine in patients undergoing rigid nasal endoscopy in terms of pain, discomfort, clarity of view of lateral nasal anatomy and overall patient and examiner preference.

Methods: A single-blinded randomized controlled clinical trial was conducted in 86 adult patients undergoing rigid nasal endoscopy at the Outpatient Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand. Nasal cavities were randomly selected to receive nasal packing or nasal spraying before nasal endoscopic procedure. Outcomes were assessed for differences in pain, discomfort, clarify of nasal anatomy during nasak endoscopic procedures as well as patient and examiner preference.

Results: There were statistically and clinically significant differences between the nasal spray groups and nasal packing groups during drug administration in the number of patients who had less pain, 46 (56.1%) vs. 17 (20.7%), patients’ pain score 2.36 vs. 3.20 and patient preference, 63.4% vs. 30.5%, respectively. During nasal endoscopic procedure, there were no clinically and statistically significant difference in the number of patients who had less pain, less discomfort, pain score and discomfort score. There was also no statistically and clinically significant difference for the choice of method of drug administrations for nasal endoscopic examination in the future. During nasal endoscopy, the endoscopist could see the middle meatus and superior meatus more clearly when nasal packing group had been performed and the endoscopist expressed a clear preference for nasal packing.

Conclusions: Nasal packing provided a clearer view of lateral nasal wall anatomy. This method of drug administration was preferred by the endoscopist. There were no clinically and statistically significance differences between both methods in terms of patients’ overall preference.