Chest
Volume 128, Issue 3, September 2005, Pages 1756-1760
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Bronchoscopy
Nebulized Lidocaine for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Trial

https://doi.org/10.1016/S0012-3692(15)52214-9Get rights and content

Objective

Topical anesthesia for flexible bronchoscopy can be administered via transcricoid injection, nebulizer, or directly through the bronchoscope in a “spray as you go” fashion. We performed a prospective, randomized, double-blind, placebo-controlled trial to evaluate whether nebulized lidocaine provides additional benefit and reduces the total anesthetic dose required during bronchoscopy.

Setting

Tertiary care university hospital.

Methods

One hundred fifty patients (93 men; age, 20 to 89 years) undergoing diagnostic flexible bronchoscopy were randomized to receive either 4 mL of 4% lidocaine (160 mg) or 4 mL of saline solution as placebo via nebulization. Combined sedation was achieved using 5 mg of IV hydrocodone and midazolam boluses. Supplemental lidocaine doses and total midazolam required as judged by the bronchoscopist were recorded for each patient. After the procedure, both bronchoscopists and patients charted their perception of cough on a 10-cm visual analog scale (VAS). Similarly, patients recorded their discomfort related to the procedure on a 10-cm VAS.

Results

The most common procedures were BAL in 77 cases (51%), transbronchial biopsy in 40 cases (27%), and transbronchial needle aspiration in 34 cases (23%). Outcome parameters, including hemodynamic findings, duration of the procedure, cough scores for physicians and patients, discomfort score for patients, midazolam doses, and supplemental lidocaine doses, were similar in both groups. Mean total lidocaine dose required in the lidocaine group was 318 ± 41 mg and was significantly higher than the total dose required in the placebo group (157 ± 44 mg [± SD]) [p < 0.001].

Conclusion

Additional nebulized lidocaine cannot be recommended for flexible bronchoscopy performed under combined sedation.

Section snippets

Patients

The study has been approved by the institutional ethical committee. After obtaining written informed consent, 150 consecutive patients undergoing diagnostic flexible bronchoscopy were prospectively randomized utilizing a computer system to receive either nebulized 4% lidocaine or placebo in a double-blind fashion. Intubated patients, those receiving propofol (eg, IV drug abuse), and patients requiring endobronchial ultrasound examination were not included in this trial.

Study Design

Bronchoscopies were

Results

Patient characteristics are presented in Table 1. All examinations could be completed as planned. There were no significant differences in age, gender, and indication for bronchoscopy between both groups. Distribution of different invasive bronchoscopic procedures performed were also similar in both groups (Table 2). The most common procedures were BAL in 77 cases (51%), followed by bronchial washings in 63 cases (42%), transbronchial biopsy in 40 cases (27%), and transbronchial needle

Discussion

This study demonstrates no additional benefit of nebulized lidocaine in reducing the total dose of topical anesthetic administered for flexible bronchoscopy in patients receiving combined sedation with midazolam and hydrocodone. Indeed, patients treated with nebulized lidocaine received overall greater amounts of lidocaine than the placebo group. Furthermore, the administration of aerosolized lidocaine prior to bronchoscopy did not significantly improve patient comfort or prevent cough.

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