DefinePK

Abstract

OBJECTIVES:The primary objective of the study was to observe the effects of nebulized Lignocaine in reducing total dose of topical anesthesia during flexible bronchoscopy; the secondary objective was to observe the difference in two groups in terms of relief of cough and patient discomfort.METHODS:Prospective, randomized, double-blind study. This study was conducted at Abbasi Shaheed Hospital Karachi Medical Unit III from July 2009 to January 2010. All adult patients, meeting inclusion criteria were selected by computerized randomization to receive either 4ml of 2% Lignocaine or 4ml of saline as placebo through nebulization over 15 min prior to bronchoscopy by face mask. Bronchoscopist was blinded to use of drug/placebo. Sedation (Midazolam) was given to patients according to the requirement (anxiety, restlessness and non-co-operation). Any amount of Lignocaine used via bronchoscopy was observed. The bronchoscopist graded the perception of cough, while patient’s discomfort was documented on pre provided grading scale by patient after 2hours (zero: no discomfort and 10: highest discomfort).RESULTS:Eighty patients were included, 40 in each group; 46 (57.5%) were males. Mean age of males was 49.52±17.82 and of females 39.47 ± 15. 69 years.Topical Lignocaine used in Lignocaine group ranged from 2 ml to 14 ml with mean dose of 6.6 ±3.078 ml, whereas in placebo group it ranged from 0 to 14 ml with mean dose of 7.9 ±3.815 ml (p=0.341). Midazolam was used in 5% patients in Lignocaine group as compared to 30% patients in placebo group. Total amount of Lignocaine used in Lignocaine group was 264 ml as compared to 580 ml used in placebo group. Total amount of Midazolam used was 10 mg in Lignocaine group as compared to 54 mg in placebo group. The mean cough perception by patient was 3.6 in Lignocaine group and 5.5 in placebo group (p=0.007). In Lignocaine group, the mean patient’s discomfort was 4.2 as compared to 5.6 in placebo group (p=0.863).CONCLUSION:Nebulized Lignocaine provided adequate anesthesia and such patients required less topical Lignocaine during bronchoscopy. Moreover, patient tolerance of procedure showed a trend towards improved tolerance although the differences in these were statistically insignificant. Amount of Midazolam used in Lignocaine pre nebulized patients was less.