Department of Pulmonary and Critical Care Medicine, Saint Louis University Hospital, Saint Louis, MO.
J Bronchology Interv Pulmonol. 2020 Oct;27(4):266-273. doi: 10.1097/LBR.0000000000000656.
Conflicting evidence of nebulized lidocaine use in bronchoscopy still exist. This study will identify whether there is any difference in various patient-related, physician-related, or procedure-related outcomes with and without lidocaine nebulization before the procedure.
The authors performed a search in 4 electronic databases, including Pubmed, Scopus, Virtual Health Library, and Google Scholar from inception to August 2019. Data on patient-reported and physician-reported outcomes, doses of sedation, and lidocaine were extracted and pooled into standardized mean difference (SMD) and mean difference (MD) using the random-effect model.
Seven randomized controlled trials with 1366 patients were included. Cough was not different between the nebulized lidocaine group and no nebulized lidocaine group (SMD, -0.12; 95% confidence interval, -0.82 to 0.59; I, 95%; P=0.75), so as operator's satisfaction score, ease of the procedure, patient's discomfort, and unwillingness to repeat the procedure. Additional nebulized lidocaine group required higher lidocaine dose (MD, 81.93; 95% confidence interval, 17.14-146.71). Studies using only local anesthesia favored the "no additional lidocaine" group in improving cough, operator's satisfaction score, and ease of the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam dose and duration of the procedure in the "additional nebulized lidocaine group."
Additional administration of nebulized lidocaine increased the total dose of lidocaine used and did not improve cough symptoms, operator-satisfaction score, ease of the procedure, and willingness to repeat the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam use and in procedure duration but the clinical significance of these findings is uncertain.
支气管镜检查中使用雾化利多卡因的证据仍存在矛盾。本研究旨在确定在操作前使用和不使用利多卡因雾化时，患者相关、医生相关或操作相关的结局是否存在差异。
作者在 4 个电子数据库（Pubmed、Scopus、Virtual Health Library 和 Google Scholar）中进行了检索，检索时间从建库至 2019 年 8 月。提取患者报告和医生报告结局、镇静剂剂量和利多卡因的数据，并使用随机效应模型将其汇总为标准化均数差（SMD）和均数差（MD）。
纳入了 7 项随机对照试验，共 1366 例患者。雾化利多卡因组和未雾化利多卡因组的咳嗽无差异（SMD，-0.12；95%置信区间，-0.82 至 0.59；I，95%；P=0.75），操作者满意度评分、操作难易程度、患者不适和不愿重复操作也无差异。额外雾化利多卡因组需要更高的利多卡因剂量（MD，81.93；95%置信区间，17.14-146.71）。仅使用局部麻醉的研究更倾向于“不额外使用利多卡因”组改善咳嗽、操作者满意度评分和操作难易程度。使用中度镇静的研究的亚组分析显示，“额外雾化利多卡因”组咪达唑仑剂量减少，操作时间缩短。
额外给予雾化利多卡因增加了利多卡因的总用量，但并未改善咳嗽症状、操作者满意度评分、操作难易程度和重复操作的意愿。使用中度镇静的研究的亚组分析显示，咪达唑仑的使用减少，操作时间缩短，但这些发现的临床意义尚不确定。
