What is the best throat anesthesia for outpatient procedures?

From the Guidelines

Benzocaine spray is the most effective option for outpatient throat anesthesia, providing rapid numbing within 30 seconds that lasts about 30-60 minutes. When considering the best throat anesthesia for outpatient procedures, it's essential to weigh the benefits and risks of available options. According to a study published in Gastroenterology 1, topical anesthetic agents such as benzocaine, lidocaine, and tetracaine have been used to facilitate upper endoscopic procedures. The study found that subjects who received pharyngeal anesthesia were more likely to rate their discomfort as none/minimal, and endoscopists were more likely to rate the procedure as "not difficult". However, it's crucial to note that topical anesthetic agents like benzocaine can be associated with a potentially life-threatening adverse event known as methemoglobinemia. To minimize this risk, it's recommended to apply 1-2 sprays of benzocaine spray directly to the throat as needed, but not exceed 4 doses in a 24-hour period.

Some key points to consider when using benzocaine spray for outpatient throat anesthesia include:

• Apply 1-2 sprays directly to the throat as needed
• Do not exceed 4 doses in a 24-hour period to avoid methemoglobinemia risk
• Monitor for signs of methemoglobinemia, such as cyanosis despite adequate supplemental oxygen delivery
• Have a treatment plan in place, including intravenous methylene blue, in case of methemoglobinemia
• Consider alternative options, such as lidocaine lozenges or phenol-containing sprays, for patients who may be at higher risk for methemoglobinemia or have persistent throat pain.

From the FDA Drug Label

Purpose Oral Anesthetic The best throat anesthesia for outpatient use is benzocaine (PO), as it is specifically labeled as an oral anesthetic 2.

From the Research

Best Throat Anesthesia for Outpatients

• The best throat anesthesia for outpatients can be determined by examining the effectiveness of various anesthetics in reducing postoperative sore throat.
• A study published in 2010 3 found that spraying benzydamine hydrochloride on the endotracheal tube cuff is a simple and effective method to reduce the incidence and severity of postoperative sore throat.
• Another study published in 2015 4 found that topical and systemic lidocaine therapy can reduce the risk of postoperative sore throat, although the effect size was affected by study quality, drug concentration, and route of administration.
• A comparative study published in 2016 5 found that benzydamine hydrochloride gel is more effective than lidocaine 5% gel and lidocaine 10% spray in reducing the incidence and severity of postoperative sore throat.
• Other studies have also investigated the use of topical anesthetics and vasoconstrictors prior to nasogastric intubation 6 and the effect of different lidocaine application methods on postoperative cough and sore throat 7.

Comparison of Anesthetics

• Benzydamine hydrochloride has been shown to be more effective than lidocaine in reducing postoperative sore throat 3, 5.
• Lidocaine 10% spray has been found to worsen postoperative sore throat compared to benzydamine hydrochloride gel and lidocaine 5% gel 5.
• Topical and systemic lidocaine therapy can reduce the risk of postoperative sore throat, but the effect size is affected by study quality and other factors 4.
• The use of topical anesthetics and vasoconstrictors prior to nasogastric intubation can reduce pain and discomfort 6.
• Different lidocaine application methods can affect the frequency of postoperative cough and sore throat 7.