Although topical intranasal cocaine remains a common anesthetic in nasal surgery, controversy surrounds its dosage and mucosal absorption. A prospective study of 12 patients undergoing nasal surgery was performed to evaluate the absorption of cocaine solution from standard cotton pledgets. Of a 160-mg cocaine solution applied, a mean amount of 102 mg or 63.8% was recovered by gas chromatography/mass spectrometry analysis. Similar analysis of nasopharyngeal packs revealed less than 1.5% cocaine loss in the nasopharynx. Serum levels of cocaine were rarely detectable and did not correlate with either the amount of nasal absorption or time of mucosal contact. These results indicate that less than 37% of cocaine is absorbed from cotton pledgets during nasal surgery. The cocaine dose of 160 mg, used by many otolaryngologists, did not result in significant plasma levels.