Local Anesthesia with Emla Cream for Maxillary Sinus Puncture

Abstract

Maxillary sinus puncture is traditionally carried out through the lateral wall of the inferior nasal meatus under local anesthesia. One problem with it is that the insertion of a cotton-tipped applicator soaked in local anesthetic is painful. Patients also dislike waiting for the anesthetic effect with the metallic applicators in the nose. In this study, we present a new, well-tolerated method of topical anesthesia for maxillary sinus puncture via the inferior meatus of the nose. Twenty adult patients with maxillary sinus infection who were undergoing bilateral maxillary sinus puncture were studied. One side of each patient's nose was anesthetized with a cotton-tipped applicator moistened with a lidocaine-adrenaline solution (LA), and the other side was anesthetized with EMLA cream instilled with a suction needle and syringe; the sides were chosen randomly. The mean “application of anesthesia” pain score on a 100-mm visual analog scale was 39.2 for the LA side and 9.1 for the EMLA side (p <.01). The anesthesia required for puncture was reached more quickly on the EMLA side than on the LA side (p =.02). The mean puncture pain score was 25.1 with LA and 8.6 with EMLA (p =.01). Fourteen patients out of the 20 (70%) found EMLA more tolerable, 3 patients (15%) found no difference, and 3 patients (15%) preferred LA (p <.01). We conclude that EMLA is better-tolerated and quicker-acting than LA for local anesthesia in maxillary sinus puncture.