Five versus ten pharyngeal sprays of 10 percent lignocaine for topical anesthesia during flexible bronchoscopy: A multicenter randomized controlled trial.
K. Madan*a (Dr), H. Iyera (Dr), M. Mishrab (Dr), G. Sindhwanib (Dr), S. Mittala (Dr), A. Mohana (Dr), V. Haddaa (Dr), R. Guleriaa (Dr)
a All India Institute of Medical Sciences (AIIMS), New Delhi, India, New Delhi, INDIA ; b All India Institute of Medical Sciences (AIIMS), Rishikesh, India, Rishikesh, INDIA
* drkaranmadan@gmail.com
Background
Ensuring adequate patient comfort is crucial during bronchoscopy. Although lignocaine spray is recommended for topical pharyngeal anesthesia, the optimum dose of sprays is unclear. We compared five vs. ten sprays of 10% lignocaine for topical anesthesia during bronchoscopy.
Methods
In this investigator-initiated, prospective, multicenter, randomized clinical trial, subjects were randomized to receive five (Group A) or ten sprays (Group B) of 10% lignocaine. The primary objective was to compare the operator-rated overall procedure satisfaction between the groups.
Results
Two hundred eighty-four subjects were randomized [143, Group A, and 141, Group B]. The operator rated overall procedure satisfaction, VAS [(mean (SD)] was similar between the groups: Group A, 74.1 (19.9), Group B, 74.3 (18.5), p=0.93. The VAS scores of patient-rated cough, [mean (SD)] [Group A, 32.5 (22.9) and Group B, 32.3 (22.2), p = 0.93], and operator rated cough [Group A, 29.8 (22.3) and Group B, 26.9 (21.5), p= 0.26] were also similar. The time to reach vocal cords, overall procedure duration, mean doses of sedatives, the proportion of subjects willing to return for a repeat procedure (if required), and complications were not significantly different. Subjects in Group A received a significantly less cumulative lignocaine (mg), mean (SD) [Group A: 293.9 (11.6), Group B: 343.5 (10.6), p<0.001).
Conclusions
Topical anesthesia with five sprays of 10% lignocaine was associated with similar operator-rated overall procedure satisfaction at a lower cumulative lignocaine exposure than ten sprays. During bronchoscopy, five sprays of 10% lignocaine should be used for pharyngeal anesthesia.
Disclosure of funding source(s): none