Hale Samuel J M, Lengyel Olivia, Louis Deanna, Kim Raymond, Douglas Richard G
Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Clin Otolaryngol. 2025 Jan;50(1):46-52. doi: 10.1111/coa.14223. Epub 2024 Sep 17.
Nasal anaesthetic-decongestant sprays are commonly used prior to nasal instrumentation, such as flexible and rigid nasal endoscopy. Co-phenylcaine (lignocaine 5%, phenylephrine 0.5%, ENT Technologies Pty Ltd., Melbourne, VIC, Australia) is a combination spray commonly used for this purpose. However, lignocaine is less potent than other local anaesthetics, and both active constituents of Co-phenylcaine have a bitter taste. It was hypothesised that a combination spray containing tetracaine and oxymetazoline would both offer more potent topical anaesthesia and have a better taste.
Four anaesthetic-decongestant nasal sprays were tested in 10 healthy participants (Co-phenylcaine, and tetracaine 0.5%, 1% and 2% with oxymetazoline 0.05%). Sensory thresholds were sequentially measured at the head of the inferior turbinate using Semmes-Weinstein monofilaments over the following hour. Participants also rated taste on a Likert-style scale, and reported whether they experienced subjective numbness of the maxillary teeth.
A median peak sensory threshold of 60 g (the maximum tested) was observed with Co-phenylcaine, but this threshold was exceeded by all the tetracaine-based sprays. Tetracaine 2% with oxymetazoline 0.05% had a significantly more rapid onset than Co-phenylcaine (4 min vs. 6 min, p < 0.05) and a longer duration of action. Eight participants reported dental numbness after administration of tetracaine 2% with oxymetazoline 0.05%, but only one participant after Co-phenylcaine. Tetracaine-based sprays were generally perceived to taste less unpleasant than Co-phenylcaine.
Tetracaine 2% with oxymetazoline 0.05% is a more potent and rapidly acting anaesthetic-decongestant spray than Co-phenylcaine, with a longer duration of action.
在进行鼻腔器械操作（如软性和硬性鼻内镜检查）之前，通常会使用鼻腔麻醉减充血喷雾剂。复方苯卡因（含5%利多卡因、0.5%去氧肾上腺素，ENT Technologies私人有限公司，墨尔本，维多利亚州，澳大利亚）是常用于此目的的一种复方喷雾剂。然而，利多卡因的效力低于其他局部麻醉剂，且复方苯卡因的两种活性成分都有苦味。据推测，一种含有丁卡因和羟甲唑啉的复方喷雾剂既能提供更强效的局部麻醉，味道也会更好。
在10名健康参与者中测试了四种麻醉减充血鼻腔喷雾剂（复方苯卡因，以及含0.05%羟甲唑啉的0.5%、1%和2%丁卡因）。在接下来的一小时内，使用Semmes-Weinstein单丝依次在下鼻甲前端测量感觉阈值。参与者还采用李克特量表对味道进行评分，并报告是否经历上颌牙齿的主观麻木感。
复方苯卡因的中位峰值感觉阈值为60克（测试的最大值），但所有含丁卡因的喷雾剂都超过了这个阈值。含0.05%羟甲唑啉的2%丁卡因起效明显比复方苯卡因更快（4分钟对6分钟，p<0.05），作用持续时间更长。8名参与者在使用含0.05%羟甲唑啉的2%丁卡因后报告牙齿麻木，但使用复方苯卡因后只有1名参与者报告牙齿麻木。一般认为含丁卡因的喷雾剂比复方苯卡因的味道更不难闻。
含0.05%羟甲唑啉的2%丁卡因是一种比复方苯卡因更有效、起效更快的麻醉减充血喷雾剂，作用持续时间更长。
