Pain during awake nasal intubation after topical cocaine or phenylephrine/lidocaine spray

Although several local anaesthetic techniques are described for nasal analgesia during awake intubation, there has been little attempt to evaluate their effectiveness. We examined pain scores associated with nasal intubation in a randomised cross-over study of 25 volunteers. Local anaesthesia consisted of topical aerosol spray using either cocaine 5% or Co-phenylcaine Forte (a proprietary mixture of phenylephrine hydrochloride 0.5% and lidocaine hydrochloride 5%), followed by lidocaine gel. Topical anaesthesia using an atomiser resulted in incomplete analgesia for insertion of nasopharyngeal airways. Larger diameter tubes resulted in higher pain scores. There was no difference in pain scores between the two drugs.