Comparison of Pre-procedure Lignocaine Spray Versus Spray-as-you-go for Topical Airway Anesthesia in Flexible Bronchoscopy

Sheikh Zayed Federal Postgraduate Medical Institute

Status: Completed

Conditions: Airway Disease; Trachea; Anesthesia, Local; Lignocaine

Treatments: Drug: Pre-procedure lignocaine spray (PPL); Drug: Lignocaine Spray (Spray-as-you-go)

Study type: Interventional

Funder types: Other

Identifiers

NCT07084623

SheikhZayedFederalPMER

Details and patient eligibility

About

Title: Comparing Two Methods of Topical Anesthesia for Fiberoptic Bronchoscopy

Purpose: To compare the effectiveness of two methods of anesthesia, pre-procedure lignocaine spray (PPL) and spray-as-you-go (SAYG), in reducing discomfort and improving operator comfort during fiberoptic bronchoscopy.

Study Design: Randomized controlled trial Participants: 50 patients undergoing fiberoptic bronchoscopy Interventions: Patients received either PPL or SAYG anesthesia

Outcomes:

• Pain perception
• Cough severity
• Operator comfort
• Procedure duration

Results:

• Both PPL and SAYG methods were effective in reducing pain and discomfort
• No significant differences were observed between the two groups in pain perception, cough scores, or procedure duration
• Operator comfort scores showed a trend favoring PPL, but the difference was not statistically significant

Implications: Both PPL and SAYG methods can be effectively used for fiberoptic bronchoscopy, with potential implications for procedural efficiency and patient outcomes.

Full description

A single-blind RCT included 50 participants were randomly assigned to two groups (n = 25 each). Standard procedural sedation with midazolam and 2 mL of 4% lignocaine spray in the oropharynx was used to suppress the gag reflex. Additionally, 2% lignocaine spray was administered during the procedure according to body weight (3 mg/kg) via oral scope insertion. Cough severity, pain perception, and operator comfort were assessed using the Visual Analogue Scale, Faces Pain Rating Scale, and a 4-point Likert scale, respectively.

Enrollment: 50 patients

Sex: All

Ages: 18 to 72 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All consecutive patients indicated for diagnostic bronchoscopy, aged over 18 years, both genders (males and females), hemodynamically stable (defined as systolic blood pressure between 100 and 180 mm Hg), and sedated with an intravenous injection of midazolam at 0.01 mg/kg.

Exclusion criteria

• Hypersensitivity to lignocaine, use of general anesthesia for the procedure or other emergency procedures, pregnancy, comorbidities such as heart failure, advanced chronic kidney disease stage 3-4, chronic liver disease, contraindications to sedation, and hypoxemia (oxygen saturation by pulse oximetry, SpO2 < 92%)

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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50 participants in 2 patient groups

Pre-procedure lignocaine spray (PPL)

Active Comparator group

Description:

Participants received: 1. Standard sedation with midazolam (0.01 mg/kg IV); 2. 2 mL of 4% lignocaine spray in the oropharynx before bronchoscopy; 3. Additional 2% lignocaine spray (3 mg/kg): * 2-4 mL sprayed over vocal cords via bronchoscope working channel * Remaining dose as single bolus into larynx/trachea

Treatment:

Drug: Lignocaine Spray (Spray-as-you-go)

Drug: Pre-procedure lignocaine spray (PPL)

Spray-as-you-go (SAYG) Airway Anesthesia

Active Comparator group

Description:

Participants received: 1. Standard sedation with midazolam (0.01 mg/kg IV); 2. 2 mL of 4% lignocaine spray in the oropharynx before bronchoscopy; 3. 2% lignocaine spray (3 mg/kg) during procedure: * Initial 2-4 mL sprayed over vocal cords * Additional doses in mainstem bronchi during scope advancement

Treatment:

Drug: Lignocaine Spray (Spray-as-you-go)

Drug: Pre-procedure lignocaine spray (PPL)