EMLA Cream as Local Anesthetic for Endoscopic Radiofrequency Volumetric Inferior Turbinate Tissue Reduction

Abstract

Objectives: Radiofrequency volumetric tissue reduction (RFVTR) is usually performed under local anesthesia. Although this is a simple procedure, patients often report perioperative discomfort. The aim of this prospective study was to determine the effectiveness of Lidocaine/prilocaine eutectic mixture (EMLATM cream) as a topical anesthetic for RFVTR. A comparison between EMLATM cream and lidocaine 10% in liquid formulation has also been made. Methods: 200 consecutive patients undergoing RFVTR with topical anesthesia were enrolled in this randomized controlled trial from March 2010 to March 2012. The patients were divided into 2 groups: Group A included 100 patients treated with cotton pledgets soaked with lidocaine 10%, and Group B included 100 patients treated with EMLATM cream. Patients were evaluated before and after surgery using endoscopy and rhinomanometry. Four 10 cm Visual Analogue Scale (VAS) were submitted to each patient immediately after surgery and after 2 months to assess various aspects of perioperative discomfort. Results: A significant increase of nasal airflow and a subjective improvement of symptoms were observed without differences between the 2 groups. Subjective evaluation regarding perioperative discomfort showed a significant difference between Group A and Group B immediately after surgery and a slight but not significant difference after 2 months. Conclusions: RFVTR is an effective technique in the treatment of turbinate hypertrophy. The unintentional passage of anesthetic liquid into the pharynx is likely the cause of greater discomfort. The higher viscosity of the EMLATM cream provides greater permanence on the nasal mucosa and a more effective anesthesia.