• Sahajal Dhooria, Shivani Chaudhary, Babu Ram, Inderpaul Singh Sehgal, Valliappan Muthu, Kuruswamy Thurai Prasad, Ashutosh N Aggarwal, and Ritesh Agarwal.
• Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
• Chest. 2020 Jan 1; 157 (1): 198-204.

BackgroundThe optimal mode of delivering topical anesthesia during flexible bronchoscopy remains unknown. This article compares the efficacy and safety of nebulized lignocaine, lignocaine oropharyngeal spray, or their combination.MethodsConsecutive subjects were randomized 1:1:1 to receive nebulized lignocaine (2.5 mL of 4% solution, group A), oropharyngeal spray (10 actuations of 10% lignocaine, group B), or nebulization (2.5 mL, 4% lignocaine) and two actuations of 10% lignocaine spray (group C). The primary outcome was the subject-rated severity of cough according to a visual analog scale. The secondary outcomes included bronchoscopist-rated severity of cough and overall procedural satisfaction on a visual analog scale, total lignocaine dose, subject's willingness to undergo a repeat procedure, adverse reactions to lignocaine, and others.ResultsA total of 1,050 subjects (median age, 51 years; 64.8% men) were included. The median (interquartile range) score for subject-rated cough severity was significantly lower in group B compared to group C or group A (4 [1-10] vs 11 [4-24] vs 13 [5-30], respectively; P < .001). The bronchoscopist-rated severity of cough was also the least (P < .001), and the overall satisfaction was highest in group B (P < .001). The cumulative lignocaine dose administered was the least in group B (P < .001). A significantly higher proportion of subjects (P < .001) were willing to undergo a repeat bronchoscopy in group B (73.7%) than in groups A (49.1%) and C (59.4%). No lignocaine-related adverse events were observed.ConclusionsTen actuations of 10% lignocaine oropharyngeal spray were superior to nebulized lignocaine or their combination for topical anesthesia during diagnostic flexible bronchoscopy.Trial RegistryClinicalTrials.gov; No.: NCT03109392; URL: www.clinicaltrials.gov.Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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