Literature Review: A Roundup of Important Recent Studies

Citation: Manica D, Schweiger C, Cauduro Maróstica PJ, Kuhl G, Antonacci Carvalho PR. Association between length of intubation and subglottic stenosis in children. Laryngoscope. 2013;123:1049-1054.

—Reviewed by Amy Eckner

Little Difference Between Tetracaine and Lidocaine for Nasal Endoscopy

Is there a difference in comfort levels and other negative side effects between use of atomized 2 percent tetracaine and 4 percent lidocaine for nasal endoscopy patients?

Background: Nasal endoscopy is generally performed in an outpatient setting, with patients given a topical anesthetic for improved comfort. However, there is no consensus on the most effective topical anesthetic for patient comfort. This study examined atomized 2 percent tetracaine and 4 percent lidocaine. According to the study authors, to date there have been no prospective, randomized trials that specifically evaluate patient discomfort, comparing tetracaine and lidocaine, during nasal endoscopy.

Study design: Prospective, randomized, double-blind study

Setting: Department of Otolaryngology, MedStar Washington Hospital Center, Washington, D.C.

Synopsis: Ninety-nine study participants enrolled between July 2011 and May 2012 were randomized to receive either tetracaine or lidocaine. Both physicians and patients were blinded to the anesthetic administered. Patients received two atomized sprays of oxymetazoline and then three sprays of the topical anesthetic; before proceeding, the investigator waited three minutes. The senior author performed all endoscopies for consistency. The mean age of participants was 58.0±16.2 years. Patients were then asked to complete a nine-question survey evaluating comfort level and adverse symptoms using a 10-point analog scale. Participants older than age 58.01±16.20 were more likely to have less overall pain and discomfort and to experience an unpleasant taste. Patients older than age 59.96±16.76 were less likely to suffer from globus sensation and dysphagia in the tetracaine group. The highest score was for unpleasant taste in both anesthetics. The authors found no significant differences between the lidocaine and tetracaine groups. No gender differences were found. Limitations of the study included inherent subjectivity, possible differences in discomfort if a longer waiting time was used, the lack of a placebo arm and a question of whether having a physician with less experience performing the endoscopies would change the results.

Bottom line: There were similar effects using 2 percent tetracaine and 4 percent lidocaine on patients undergoing transnasal fiberoptic endoscopy, although tetracaine may be a better choice for older patients.

Citation: Gaviola GC, Chen V, Chia SH. A prospective, randomized, double-blind study comparing the efficacy of topical anesthetics in nasal endoscopy. Laryngoscope. 2013;123:852-858.