Nebulized lidocaine for flexible bronchoscopy: a randomized, double-blind, placebo-controlled trial.
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.


METHODS
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].


CONCLUSIONS
Additional nebulized lidocaine cannot be recommended for flexible bronchoscopy performed under combined sedation.
Stolz
Daiana
D
Division of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland. daistolz@yahoo.com
Chhajed
Prashant N
PN
Leuppi
Jörg
J
Pflimlin
Eric
E
Tamm
Michael
M
D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local; D001999:Bronchoscopy / Q000379:methods*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008012:Lidocaine; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D006853:Hydrocodone; D008012:Lidocaine; D008874:Midazolam