Topical nasal anaesthesia for fibreoptic bronchoscopy: lignocaine spray or gel?

Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. Throat anaesthesia was the most common unpleasant part experienced by both groups of patients (34.5%), followed by examination of bronchi (30.6%) and nasal anaesthesia (21.8%). Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.