The aim of this prospective study was to evaluate the efficacy of cocaine flakes compared to tetracaine with adrenaline solution, as a local anaesthetic for patients undergoing septoplasty. From January 2001 to December 2002, 220 patients underwent septoplasty under local anaesthesia. Patients were randomly classified in group A and group B, where cocaine and the solution of tetracaine/adrenaline were used respectively. A visual analogue scale was used to evaluate the severity of the patients'pain during the procedure. The patients of group B showed a statistically significant lower pain score than patients of group A. We believe that the solution of tetracaine/adrenaline is an effective and safe anaesthetic for patients undergoing septoplasty under local anaesthesia.