Tetracaine for ENT Procedures

Tetracaine for ENT Procedures

Tetracaine is a strong ester that’s commonly used in ENT operations as a topical anesthetic. Tetracaine can be used to anesthetize mucosal membranes that are easy to access, such as the larynx, trachea, & esophagus. The effects begin within 6–12 minutes and may last up to 2 hours. Tetracaine is a 10x stronger topical anesthetic than procaine and it’s been proven to be a better choice for nasal surgeries. It’s also more effective than lidocaine at reducing pain perception, and it works best when paired with oxymetazoline.

Many operations that previously required sedation can now be completed in the doctor’s office using only a topical anesthetic thanks to the development of less invasive technologies. Endoscopic procedures have improved in recent years, allowing ENT specialists to better reach as well as visualize the areas of the body they treat. The application of a local anesthetic such as tetracaine can typically remove the discomfort and pain of minimally invasive in-office procedures. Tetracaine is being used in the following applications:

  • Laryngology
  • Otology
  • Rhinology
  • General otolaryngology 

Most Common Doses

Tetracaine for ENT Procedures
Tetracaine for ENT Procedures

Tetracaine is a safe and effective choice for topical local anesthesia in many ENT procedures when used correctly, so physicians need to ensure they’re following proper protocols and safety precautions when administering the anesthetic. With the right dose, tetracaine can provide effective topical anesthesia that lasts up to four hours. The most common doses of tetracaine used for ENT procedures are 0.5–4% for topical application, although higher concentrations can also be used depending on the procedure being performed. Tetracaine can be administered via direct application to mucous membranes, submucosal injection, or infiltration into the soft tissue of the face and neck. 

The concentration and amount of tetracaine used will depend on the specific procedure being conducted and should be ordered by a physician. When using tetracaine for ENT procedures, it’s important to follow proper protocols and safety precautions to ensure patient safety. Proper dosing is essential to avoid any adverse effects or complications that may arise from too much or too little of the anesthetic. It’s also important to monitor vital signs regularly during the procedure and administer oxygen if needed. 

Tetracaine With Vasoconstrictors

Tetracaine, combined with a vasodilator, Tetracaine is even more effective than tetracaine alone. A vasoconstrictor lets the anesthetic linger in the area where it was applied for longer, allowing it to have a longer impact. The delay of uptake into the circulation also has a systemic effect. This is useful for several topical anesthetics that we compound. For example, we frequently use phenylephrine as a vasoconstrictor in our local anesthetics for dentists. Tetracaine is frequently used with phenylephrine or oxymetazoline for ENT procedures.

Vasoconstrictors can also assist in decongesting the body before surgery. Congestion caused by the use of equipment during nasal procedures is a common source of discomfort. Decongestants such as oxymetazoline and phenylephrine are used to make the process more comfortable. When it comes to lowering discomfort during an operation, a combination of both a vasoconstrictor and tetracaine can be just as efficient as cocaine (a strong anesthetic and vasoconstrictor).

Read More: Topical Anesthetic Solutions For Laryngoscopy You Should Know

Tetracaine: Application Procedure

Depending on the operation, a tetracaine solution is often administered with gentle pledgets, a sprayer, or drops. The cream form of topical anesthetics is applied on the skin.

A tetracaine & oxymetazoline solution may be sprayed in the nasal passages as a suppressant before treatment, such as a balloon sinuplasty. The same (or a stronger) solution will then be administered to the nasal canal using gentle pledgets that will be left in for around 20 minutes. The middle aperture — where the sinus drains into — can then be utilized with an endoscope to put tetracaine-soaked pledges. The area must be examined once the anesthesia has been correctly placed to confirm that there will be no pain during the surgery.

Tetracaine topical solution is also used for several other procedures. It has been found to minimize the discomfort caused by laryngoscopy as well as other visualization techniques. Between 5–10 ml of tetracaine solution can be administered to the eardrum for a myringotomy. Other techniques may require the solution to be sprayed onto the larynx to coat it. Mouth rinses with anesthetics are sometimes used to numb both the mouth and throat.

Before injecting the local anesthetic, a tetracaine solution can be sprayed. The injection is made easier and much more comfortable with the use of a topical anesthetic. A local anesthetic cream can be used to inject anesthesia outside the nose or elsewhere on the skin. Benzocaine, lido, and tetracaine cream (BLT cream) is the greatest topical numbing lotion for the skin and is commonly used before dermatology and aesthetic procedures.

Negative Effects

Negative Effects
Negative Effects

Dosing should not exceed 1.5–3 mg/kg of the patient’s weight. The site of application also has an impact on the drug’s toxicity. Tetracaine is absorbed in the following order from fastest to slowest: IV > intercostal > caudal > epidural > brachial plexus > subcutaneous. Avoiding locations with significant vascular supply nearby. Adding topical vasoconstrictors to the solution will help reduce absorption speed (epinephrine or phenylephrine). Patients with liver disease, neonates, and individuals with atypical homozygous pseudocholinesterase deficiencies should be carefully dosed.

As with other local anesthetics, Central Nervous System (CNS) toxicity is a major worry with tetracaine. Toxicity might start with numbness around the mouth, tinnitus, hazy vision, and dizziness. Due to the blocking of CNS inhibitory mechanisms, the patient may experience hyperexcitability before advancing to depressive symptoms, seizures, as well as a comatose condition before the hemodynamic collapse. When taken at hazardous levels, tetracaine has vasodilatory characteristics and reduces heart contractility in a dose-dependent manner. Furthermore, it may lengthen the PR and QRS intervals, leading to sinus bradycardia and eventually asystole. 

Tetracaine can cause allergic responses. While local anesthetic allergy is uncommon, it’s more frequent with aminoesters than with aminoamides. This reaction appears to be caused predominantly by para-aminobenzoic acid (PABA). It’s important to check the prescription label for any preservatives, particularly methylparaben, which contains PABA. 


Apart from prior signs of a severe allergic reaction, there are no absolute contraindications to using tetracaine. The use of a local anesthetic before this is a relative contraindication. When a patient has gotten pharmaceuticals such as surgical pain relief when a local anesthetic infiltration has been used, the duration of the action of different agents should be carefully noted. 

Bottom Line

Tetracaine is a widely used anesthetic for ENT procedures, such as surgery and minor procedures. This powerful drug works quickly to numb the affected area, making it ideal for patients who need fast pain relief during their treatment.

While tetracaine is generally considered safe and effective, some potential side effects can occur, including dizziness, difficulty breathing, and nausea. As always, it’s important to consult with your doctor before undergoing any kind of ENT procedure to ensure that tetracaine is the right for you.

Whether you need ENT surgery or a minor procedure like tonsil removal, tetracaine can help ease your pain and make your treatment more comfortable. 

Do you need more information or guidance on how you can benefit from our compounded medicines? At King’s Pharmacy & Compounding Center, we want what’s best for your health and will work to find the right solutions for you. To learn more, visit https://kingspharma.com/.