Lidocaine is the most commonly used topical anesthetic during bronchoscopy. Tetracaine is used by less than 3% of bronchoscopists in North America, but may produce better topical anesthesia. There have been no prospective trials comparing lidocaine with tetracaine during bronchoscopy.
Fifty-four patients were enrolled in a prospective double-blinded, randomized trial comparing 0.45% tetracaine with 1% lidocaine in adult patients undergoing awake flexible bronchoscopy. Primary outcomes included patient and physician estimation of pain and cough using a 100 mm visual analogue scale. Secondary outcomes included cough count, change in heart rate during the procedure, and willingness to undergo the procedure again. Demographic variables were analyzed against the primary and secondary outcomes in a multivariate analysis. All bronchoscopies were performed using only topical anesthesia.
The two study groups were well matched for age, gender, smoking history, basal heart rate, procedure performed, and duration of procedure. The average dose of tetracaine and lidocaine were 124 mg and 266 mg (respectively). There was no statistically significant difference in patient estimation of pain with tetracaine vs. lidocaine (22 mm vs. 27 mm, p-value 0.74), patient estimation of cough (27 mm vs. 34 mm, p-value 0.45), bronchoscopist estimation of pain (25 mm for both), or bronchoscopist estimation of cough (34 mm vs. 40 mm, p-value 0.60). Change in heart rate during the procedure was similar for tetracaine and lidocaine (25 vs. 29 beats per minute, p-value 0.94). Cough count during the procedure was higher for lidocaine; however this difference was not statistically significant (21 vs. 13 coughs, p-value 0.31). A greater percentage of patients were willing to undergo the procedure again using tetracaine than lidocaine (26/26 vs. 22/28, p-value 0.02). Adverse reactions were uncommon, but occurred more commonly with lidocaine. Only two procedures had to be terminated prematurely, however both occurred in the lidocaine group.
In this prospective randomized trial, tetracaine was equivalent to lidocaine for topical anesthesia during bronchoscopy.
Tetracaine should be considered as an alternative to lidocaine during bronchoscopy.
Konrad Davis, No Financial Disclosure Information; No Product/Research Disclosure Information