Topical Cocaine Solution in Rhinoplasty and Plastic Surgery
Prescribe with Town & Country Compounding
Clinical Reference for Prescribers: Not Intended for Patient Use
Town & Country Compounding (T&C) can prepare Cocaine HCl-Tetracaine HCl (Benzalkonium) Rhinoplasty Solution, a patient-specific compounded nasal anesthetic commonly used by surgical teams performing rhinoplasty, septoplasty, and other sinonasal procedures. It is a combination formulation rather than a single-agent cocaine solution, and it is available with or without a visualization dye, under an individual prescription, so your practice can specify what your protocol calls for.
Why Compound a Combination Instead of Cocaine Alone
Cocaine's local anesthetic effect and its vasoconstrictive effect come from the same molecule acting through the same underlying mechanism, norepinephrine reuptake inhibition. Tetracaine's anesthetic effect comes from a different mechanism, a pure ester-based sodium channel block, with no vasoconstrictive activity of its own. These are two distinct modes of anesthetic action rather than two versions of the same one.
Combining the two means the formulation carries both mechanisms of anesthetic action in a single application, cocaine's and tetracaine's, alongside cocaine's vasoconstrictive effect. That is the clinical rationale for building a combination formulation rather than defaulting to a single-agent cocaine solution.
Why a Dye Makes a Difference in the Field
T&C can compound this solution with a pharmaceutical-grade dye added, giving the surgical team a clear visual marker of where it has been placed:
- Faster visual confirmation that both nasal cavities received even, complete coverage
- Reduced risk of an unaccounted-for pledget being left in place at the end of the case
- A clear visual distinction from other clear solutions on the surgical tray
- Easier coordination between surgeon and staff when multiple pledgets are placed and repositioned during a procedure
- Color of the solution differentiates it from other drugs being used during the procedure
A Compounding Partner That Gets You What the Case Requires
This is the role a compounding pharmacy is built for: preparing what a specific patient and a specific procedure call for, on a prescription-by-prescription basis, built around the pharmacology the case actually needs rather than a single off-the-shelf agent.
T&C works directly with surgeons and surgical centers to prepare Cocaine HCl-Tetracaine HCl (Benzalkonium) Rhinoplasty Solution to the specific volume and formulation your protocol calls for, patient by patient, with or without dye, so the solution you want is the one you get.
Frequently Asked Questions
Why combine cocaine and tetracaine instead of using a single-agent cocaine solution?
Cocaine and tetracaine each anesthetize nasal mucosa through a different mechanism, and cocaine alone also provides the vasoconstriction that tetracaine lacks. Compounding the two together carries both anesthetic mechanisms plus cocaine's vasoconstrictive effect in a single application, rather than relying on one agent to do everything.
What does adding a visualization dye do during surgery?
A pharmaceutical-grade dye gives the surgical team a clear visual marker of where the solution has been placed, helping confirm even coverage of both nasal cavities and distinguishing the solution from other clear liquids on the surgical tray.
Is this compounded solution legal to prescribe?
Yes. Cocaine HCl-Tetracaine HCl (Benzalkonium) Rhinoplasty Solution requires a valid, patient-specific prescription and is dispensed for use by licensed practitioners in a clinical or surgical setting in accordance with applicable state and federal law.
Is this a controlled substance?
Yes. This formulation contains cocaine hydrochloride, a Schedule II controlled substance, and is prepared and dispensed accordingly.
Prescribe with T&C
Compounded Cocaine HCl-Tetracaine HCl (Benzalkonium) Rhinoplasty Solution requires an individual, patient-specific prescription. As a PCAB-accredited (through ACHC) and NABP-accredited compounding pharmacy, T&C can prepare this nonsterile topical formulation, with or without dye, and coordinate directly with your surgical center or practice on turnaround and handling.
If your practice performs rhinoplasty, septoplasty, or other sinonasal surgery and would like to discuss compounded formulations for your practice, our team is glad to walk through the details with you and your prescribers.
Talk to T&C About This Formulation →This formulation contains cocaine hydrochloride, a Schedule II controlled substance. Compounded preparations are dispensed only pursuant to a valid, patient-specific prescription for use by licensed practitioners in a clinical or surgical setting, in accordance with applicable state and federal law.
References
Noorily AD, Noorily SH, Otto RA. Cocaine, Lidocaine, Tetracaine: Which Is Best for Topical Nasal Anesthesia? Anesthesia & Analgesia. 1995;81(4):724-727.
Tarver CP, Noorily AD, Sakai CS. A Comparison of Cocaine vs. Lidocaine with Oxymetazoline for Use in Nasal Procedures. Otolaryngology-Head and Neck Surgery. 1993;109(4):653-659.
Campbell JP, Campbell CD, Warren DW, Prazma TU, Pillsbury HC. Comparison of the Vasoconstrictive and Anesthetic Effects of Intranasally Applied Cocaine vs. Xylometazoline/Lidocaine Solution. Otolaryngology-Head and Neck Surgery. 1992;107(5):697-700.
Comparative Evaluation of Cocaine Versus Epinephrine Solutions as Topical Vasoconstrictors in Cosmetic Rhinoplasty. Aesthetic Plastic Surgery. 2016. PMID: 27357633.
Feehan HF, Mancusi-Ungaro A. The Use of Cocaine as a Topical Anesthetic in Nasal Surgery. Surv Rep Plast Reconstr Surg. 1976;57:62-65.
