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Tetracaine for ENT Procedures

Tetracaine for ENT Procedures

Tetracaine is a potent ester used as a topical anesthetic for ENT procedures. Tetracaine is effective for anesthetizing accessible mucous membranes including the larynx, trachea, and esophagus. Onset is within 6-12 minutes and the effects can last up to two hours. Tetracaine has ten times the potency of procaine and has been shown to be a superior topical anesthetic for nasal procedures. It produces greater decreases in pain perception than lidocaine, and is most effective when combined with oxymetazoline.

Many procedures that once required sedation now can be done in-office with only topical anesthetic. The development of less invasive techniques has made many procedures easier for patients. Endoscopic technology has become more advanced, allowing ENT doctors to better access and visualize areas that are treated. The pain and discomfort of in-office procedures that are minimally invasive can usually be eliminated with the use of a topical anesthetic like tetracaine. Tetracaine is used in:

  • Laryngology
  • Otology
  • Rhinology
  • General Otolaryngology

 

Tetracaine with Vasoconstrictors

The combination of tetracaine with a vasoconstrictor is more effective than tetracaine used alone. A vasoconstrictor helps the anesthetic stay in the area it was administered longer, prolonging its effects. Systemic effects are also reduced by the slowing of absorption into the blood. This is an effective method for a variety of topical anesthetics we compound. In our topical anesthetics for dentists, for example, we often include phenylephrine as vasoconstrictor. For ENTs, we most often compound tetracaine with oxymetazoline or phenylephrine.

Vasconstrictors also help with decongestion prior to a procedure. Discomfort associated with nasal procedures is often due to congestion while instruments are being used. Oxymetazoline and phenylephrine act as decongestants to make the procedure more comfortable. The combination of a vasoconstrictor and tetracaine can be as effective as cocaine (a potent anesethic and vasoconstrictor) at reducing discomfort during a procedure.

 

Application Procedure

Tetracaine solution is often applied with soft pledgets, a spray, or in drops depending on the area of the procedure. Topical anesthetics used on the skin are made into a cream form.

For a procedure like a balloon sinuplasty, a tetracaine and oxymetazoline solution may first be sprayed in the nasal passages as a decongestant. Then the same solution (or a stronger one) will be applied using soft pledgets that are left in the nasal passage for about 20 minutes. An endoscope may then be used to place tetracaine-soaked pledgets in the middle opening – where the sinuses drain into. After the anesthetic has been properly applied, the area should be tested to ensure that it is numb and that there will be no pain during the procedure.

Topical tetracaine solution is used for a variety of other procedures. It has been shown to significantly reduce discomfort from laryngoscopy and other visualization methods. For a myringotomy, 5-10 drops of tetracaine solution can be applied to the tympanic membrane. Other procedures may require that the solution be administered in a spray form to coat the larynx. Anesthetic mouth rinses are also sometimes used to numb the entire mouth and throat.

A tetracaine solution may be sprayed before injection of local anesthetic. The topical anesthetic makes the injection easier and more comfortable. If anesthetic needs to be injected on the outside of the nose or anywhere on the skin, a topical anesthetic cream may be used. The best topical numbing cream for the skin is a benzocaine, lidocaine, tetracaine cream (BLT cream) – which is often used before dermatological and aesthetic procedures.

 

Allergies and Reactions

  • Although true allergic reactions to topical anesthetics are rare, dyclonine may be used if a patient is allergic to both amide and ester anesthetics. Dyclonine has a rapid onset of 2-10 minutes but the duration of action is shorter than with tetracaine.
  • Food and drink should be avoided post-procedure in case the throat is still numb, which can cause the patient to aspirate.

 

Examples of Tetracaine Solution Formulations

Multiple strengths and combinations of tetracaine solution are available. To view more combinations download our prescription form here. Please call our office to request a password to view the page. Some common formulations we compound include:

  • Tetracaine 2%, 4%, or 6%
  • Tetracaine 2%, Phenylephrine 1% Solution
  • Tetracaine 2%, Oxymetazoline 0.05% Solution

 

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