Improved Outcomes With Spray vs Nebulized Lidocaine for Bronchoscopy

Patients undergoing flexible bronchoscopy who received lignocaine (lignocaine) as an oropharyngeal spray had reduced patient- and bronchoscopist-rated severity of cough compared with those who received nebulized lidocaine or the combination, according to the results of a recent study published in CHEST.

Perceptions of cough severity were evaluated by study participants and bronchoscopists following flexible bronchoscopy in which anesthesia was administered as either lidocaine as an oropharyngeal spray (10 actuations of 10% lidocaine), nebulized lidocaine (2.5 mL of 4% solution), or a combination of both. Cough severity was then compared between groups. Secondary outcome included overall procedural satisfaction, total lidocaine dose, and participant’s willingness for a repeat procedure.

Of the 1050 study participants, the median age was 51 years, and 64.8% of the population were men. The oropharyngeal spray group had a significantly lower participant- and bronchoscopist-rated cough severity than those who received either nebulized lidocaine or the combination (P <.001). Furthermore, the overall satisfaction and proportion of patients willing to repeat the procedure were higher in the oropharyngeal spray group vs the nebulized lidocaine or combination groups (73.7% vs 49.1% and 59.4%, respectively). Finally, the cumulative lidocaine dose administered was the lowest in the oropharyngeal spray group (P <.001).

“[T]he results of this study suggest that the use of 10 actuations of 10% lidocaine spray delivered to the oropharynx resulted in superior topical anesthesia as compared to nebulized lidocaine or their combination, during diagnostic flexible bronchoscopy,” the researchers wrote.

One possible limitation was the dose, as noted by the authors, so the effectiveness of fewer number of actuations is unknown.   

Reference

Dhooria S, Chaudhary S, Ram B, et al. A randomized trial of nebulized lignocaine, lignocaine spray or their combination for topical anesthesia during diagnostic flexible bronchoscopy [published July 9, 2019]. CHEST. doi:10.1016/j.chest.2019.06.018