Can Topical Lignocaine Improve Patient Comfort in EBUS-TBNA?

TOPLINE:

In patients undergoing endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) under general anesthesia, topical anesthesia with 1% lignocaine significantly reduced cough rate and increased their satisfaction with the procedure.

METHODOLOGY:

• Researchers conducted a prospective randomized double-blind trial at a hospital in China (June to September 2023) to evaluate the effect of topical lignocaine on the comfort of patients undergoing elective EBUS-TBNA under general anesthesia.
• They included 196 patients with American Society of Anesthesiologists physical status I or II who were randomly assigned to receive lignocaine (n = 91; median age, 63 years; 60.4% men) or saline (control; n = 94; median age, 62 years; 56.4% men).
• Following induction of general anesthesia and successful insertion of a laryngeal mask airway, the patients received either 20 mL of 1% lignocaine or saline, which was spread via a bronchoscope over the vocal cords and bronchi before the procedure. Neuromuscular blockade was reversed after the procedure.
• The primary outcome measured was the frequency of coughing immediately following laryngeal mask airway removal, calculated over 3 minutes.
• Secondary outcomes included patient comfort, assessed via cough intensity rated on a visual analog scale; changes in vital signs; adverse events; and postoperative pulmonary complications. Quality of Recovery-15 scores were assessed a day before surgery (baseline) and 24 and 72 hours after the procedure.

TAKEAWAY:

• Topical anesthesia with lignocaine before EBUS-TBNA significantly reduced the cough rate immediately (P < .001), 10 minutes (P < .001), and 30 minutes (P = .005) after removal of the laryngeal mask airway, and the effects persisted up to 2 hours after surgery (P = .003).
• The scores for cough intensity were significantly lower in the lignocaine group than in the control group immediately (P < .001), 10 minutes (P < .001), and 30 minutes (P = .001) after removal of the airway, as well as 2 hours after procedure (P = .006).
• The Quality of Recovery-15 scores were higher for patients who received lignocaine than for those in the control group 24 hours after the procedure (P < .001), with scores returning to baseline 72 hours after the procedure in both groups.
• No significant differences in vital signs, postoperative pulmonary complications, or adverse events were observed between the lignocaine and control groups.

IN PRACTICE:

“The findings from the present study may support that topical anesthesia is still necessary to prevent postoperative coughing” after EBUS, the authors of the study wrote. “Topical anesthesia should be routinely administered to patients undergoing EBUS-TBNA under general anesthesia,” they added.

SOURCE:

The study was led by Sen Zhang and Wannan Chen of Fudan University in Shanghai, China. It was published online on February 21, 2025, in Anaesthesia Critical Care & Pain Medicine.

LIMITATIONS:

Lignocaine was administered only before the procedure, leaving the potential benefits of additional supplementation unclear. Long-term postoperative pulmonary complications were not recorded. The single-center design of the study may have limited the generalizability of the findings.

DISCLOSURES:

The study did not receive any specific funding. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.