PURPOSE: Optimal dosage and strength of topical lignocaine that should be used during fibre-optic bronchoscopy (FOB) has long been controversial. The British Thoracic Society (BTS) guidelines on diagnostic FOB recommends maximum dosage of 8.2 mg/kg body weight. Control of cough is most important for quality of bronchoscopy. However, cough suppression , using higher dose of lignocaine has its own problems. In this study, authors compared the efficacy of 1% lignocaine(Gr-A) vs 2% lignocaine(Gr-B) in controlling cough, as measured on visual analogue scale (VAS), cough severity score and cough frequency score.
METHODS: 52 consecutive patients who underwent FOB were recruited in a double blind study to receive either 1% or 2% lignocaine by “spray as you go” technique after being randomly divided in two groups. Cough severity score, cough frequency score and VAS were analyzed by single investigator and all FOB were performed by same bronchoscopist to avoid bias.
RESULTS: Both populations matched on demographic profile as well as baseline characteristics. When compared on cough severity score, occasional hums were present in 57.7% in both the groups. Mild cough was present in 15.4% in Gr-A versus 23.1% in Gr-B, moderately severe cough in 26.9% in Gr-A versus 19.2% in Gr-B. There was no significant difference in the cough severity score of 2 groups (p=0.693). Similarly when assessed on cough frequency score, it was occasional cough in 53.8% in Gr-A versus 57.7% in Gr-B. mild cough was present in 26.9% of both groups and was moderate in 19.2% in Gr-A and 15.3% in Gr-B. There was no significant difference in the frequency of cough score between 2 groups (p=0.788). When compared on VAS for cough and patient perception, both groups had comparable VAS score without any significant difference (p=0.522).
CONCLUSIONS: There was no significant difference between use of 1% and 2% lignocaine for topical anesthesia when assessed by cough severity, cough frequency and patient perception.
CLINICAL IMPLICATIONS: The autors recommend 1% lignocaine for topical anesthesia as universal practice for FOB.
DISCLOSURE: The following authors have nothing to disclose: Avdhesh Bansal, Sumara Maqbool, Ravi Jha
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