Buffered Lidocaine for Topical Nasal Anesthesia: A Double-Blind Randomized Controlled Trial

Area of Science:

• Otolaryngology
• Anesthesiology
• Medical Procedures

Background:

• Transnasal fiberoptic laryngoscopy (TFL) is a common otolaryngology procedure.
• Lidocaine spray is a standard local anesthetic for TFL.
• The efficacy of buffered lidocaine for intranasal anesthesia is not well-established.

Purpose of the Study:

• To compare the effectiveness and side effects of buffered lidocaine versus plain lidocaine for nasal anesthesia during TFL.
• To evaluate patient-reported pain and adverse events.

Main Methods:

• A double-blind, randomized controlled trial involving 70 patients undergoing TFL.
• Patients received either plain lidocaine 5% spray or buffered lidocaine 5% (with 8.4% bicarbonate).
• Pain was assessed using a visual analog scale (VAS), and side effects were rated on a 10-point scale post-procedure.

Main Results:

• No significant difference in VAS pain scores between buffered and plain lidocaine groups (P=0.45).
• Plain lidocaine showed significantly lower incidence of topical burning sensation (P<0.001), throat discomfort (P=0.001), and headache (P=0.04).
• No significant differences were observed for other assessed parameters.

Conclusions:

• Plain lidocaine nasal spray provides comparable local anesthesia to buffered lidocaine for TFL.
• Plain lidocaine demonstrates a superior side effect profile, with less burning, throat discomfort, and headache.