Local Anesthetic Technique

Either cophenylcaine (a mixture of lignocaine and norepinephrine) or a 6-10% solution of cocaine can be placed on a patte or thin ribbon gauze in the nasal airway for several minutes before replacing it in the middle meatus and nasal airway more posteriorly (Fig. 10.1a, b). Although an initial spray of the solution can be used, much of it ends up in the oropharynx. This produces an unpleasant sensation for the patient, making them feel there is something there and that they have to continually try to swallow it away. After 5 minutes the patte can be removed and local anesthetic injected using 1-2% lignocaine with norepinephrine 1 : 200 000 using a dental needle. Bending the end can help to deliver it at the correct angle. We inject less than 1 ml into the lateral nasal wall just behind the anterior lacrimal crest. We do not inject the inferior turbinate.

Nerve blocks in both the sphenopalatine area (just below and lateral to the base of the middle turbinate) and, where posterior surgery is indicated, in the greater palatine foramen, can help supplement local infiltration. It often helps to leave the cophenylcaine-soaked patte in position while you move on to work in another area or the other side in order to maximize both anesthesia and vasoconstriction.

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