Madan Karan, Biswal Shiba K, Mittal Saurabh, Hadda Vijay, Mohan Anant, Khilnani Gopi C, Pandey Ravindra M, Guleria Randeep
Department of Pulmonary Medicine and Sleep Disorders.
Department of Biostatistics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, India.
J Bronchology Interv Pulmonol. 2018 Apr;25(2):103-110. doi: 10.1097/LBR.0000000000000458.
The ideal concentration of lignocaine for topical anesthesia in bronchoscopy remains investigational. In this randomized, double blind study, we compared 1% versus 2% lignocaine for topical anesthesia.
Consecutive patients undergoing bronchoscopy were randomized to receive either 1% or 2% lignocaine solution by spray-as-you-go technique. All received 10% lignocaine spray to the oropharynx along with nasal 2% lignocaine gel. Nebulized lignocaine was not administered. Primary outcomes were operator-rated overall procedural satisfaction, visual analogue scale (VAS)-rated and operator-rated cough, VAS. Secondary objectives were total lignocaine dose administered, patient-rated pain on faces pain scale, cumulative dose of lignocaine and procedural complications.
A total of 500 patients (250 in each group) were randomized. Baseline characteristics were comparable. Operator-rated overall procedural satisfaction, VAS (72.05±20.16 and 72.20±21.96 in 1% and 2% group respectively; P=0.93) and operator-rated cough, VAS [1% group: 19.1 (12.6-34.6) and 2% group: 20.6 (12.5-36.9); P>0.05] were similar between the 2 groups. Cumulative dose of lignocaine used in 2% lignocaine group was greater (220.89±12.96 mg in 1% and 319.55±19.32 mg in 2% group; P<0.001). Patients receiving sedation were comparable between the 2 groups. (10% in 1% lignocaine group and 6% in 2% lignocaine group; P=0.13). Minor complications occurred in 2 patients in each group.
One percent lignocaine in flexible bronchoscopy is as efficacious as 2% lignocaine when administered using the spray as you go technique without concurrent lignocaine nebulization, at a significantly lower total dose of lignocaine administered.
支气管镜检查中局部麻醉的理想利多卡因浓度仍在研究中。在这项随机双盲研究中，我们比较了1%与2%利多卡因用于局部麻醉的效果。
连续接受支气管镜检查的患者通过边走边喷技术随机接受1%或2%利多卡因溶液。所有患者均接受10%利多卡因喷雾至口咽以及鼻腔2%利多卡因凝胶。未给予雾化利多卡因。主要结局为术者评定的总体操作满意度、视觉模拟量表（VAS）评定的咳嗽及术者评定的咳嗽VAS。次要目标为利多卡因总给药剂量、患者面部疼痛量表评定的疼痛、利多卡因累积剂量及操作并发症。
共500例患者（每组250例）被随机分组。基线特征具有可比性。术者评定的总体操作满意度、VAS（1%组和2%组分别为72.05±20.16和72.20±21.96；P = 0.93）以及术者评定的咳嗽VAS [1%组：19.1（12.6 - 34.6），2%组：20.6（12.5 - 36.9）；P>0.05]在两组间相似。2%利多卡因组使用的利多卡因累积剂量更大（1%组为220.89±12.96mg，2%组为319.55±19.32mg；P<0.001）。两组接受镇静的患者具有可比性。（1%利多卡因组为10%，2%利多卡因组为6%；P = 0.13）。每组各有2例患者发生轻微并发症。
在不进行雾化利多卡因同时使用边走边喷技术时，柔性支气管镜检查中1%利多卡因与2%利多卡因效果相同，但利多卡因总给药剂量显著更低。
