Comparison of Tolerance and Cost‐Effectiveness of Two Nasal Anesthesia Techniques for Trans‐nasal Flexible Laryngoscopy (TFL)

Abstract

Objectives: 1) Compare tolerance of aerosolized spray vs. syringe administration of topical anesthesia for TFL. 2) Analyze cost-effectiveness of both techniques. Methods: Prospective, blinded, randomized trial. 108 patients underwent TFL over a 3-month period. Patients were randomized to receive equivalent dose of 1:1 neosynephrine/4% plain lidocaine mixture via either aerosolized spray (“spray”) or application with 1-cc syringe (“syringe”). Patients and physicians independently rated comfort of TFL on a 5-point scale (1=not at all comfortable to 5=very comfortable). Data was collected on patient and endoscopist experience with TFL as well as reasons for poor tolerance of laryngoscopy. Cost analyses of disposable spray tips and syringes were calculated. Results: Both patients and physicians reported very high tolerance of TFL. There was no difference in patient tolerance between spray- vs. syringe-administered anesthesia ( P = 0.89). Poor tolerance of laryngoscopy was reported in 6.5% with comparable distribution between anesthetic methods ( P = 0.93). There was no impact of patient prior experience with TFL ( P = 0.280), and there was no difference between anesthetic methods for TFL performed by the resident, fellow, or attending. The difference between costs of the disposable spray tip vs. syringe was $1.30 per unit. Conclusions: Use of a 1-cc syringe is an effective method to provide topical nasal anesthesia for TFL and saves $1.30 per unit compared to disposable spray tips. In our practice, transition to syringe-administered nasal anesthesia is projected to save $1,300 per 1,000 patients, or an anticipated $3,000 per year, with continued excellent patient tolerance of TFL.