To compare two different techniques for the application of topical lidocaine for local anesthesia during endobronchial ultrasound (EBUS) bronchoscopy.
We conducted a prospective, non-blinded, randomized trial to test whether spray catheter delivery of lidocaine could improve overall tolerance of EBUS bronchoscopy. We enrolled only patients with plans for curvilinear EBUS bronchoscopy under conscious sedation. All patients received upper airway albuterol nebulizer followed by 2% lidocaine atomizer and 4% lidocaine cotton ball swab using McGill forceps-application from the same investigator throughout the study. Patients were randomly assigned to the spray catheter or standard instillation of lidocaine via working channel. Lidocaine was administered in a uniform fashion by an established protocol by a single investigator throughout the study. The primary endpoints were: total dosage of lidocaine; total dosage of intravenous conscious sedation; and number of coughing episodes during the first 30 minutes of the procedure. A coughing episode was defined as a cough that required an intervention by the bronchoscopist to administer more medication.
Nineteen patients were included in the study, eleven patients in the spray catheter group and eight patients in the standard instillation group. The mean number of coughing episodes in the first 30 minutes was 0.55 (spray catheter group) and 1.75 (standard instillation), which was statistically significant (p = 0.0193). The median values was 1 (spray catheter) and 2 (Standard instillation). The mean amount of lidocaine for the first 30minutes was 12.09milligrams(spray catheter) and 15.5milligrams (standard instillation), which was statistically significant (p = 0.0022). The average dose of intravenous medications in the first 30 minutes in the spray catheter group was 4.6 milligrams of Midazolam, 113.6micrograms of Fentanyl, and 1.14milligrams of Diphenhydramine; compared with 5.38/128.12/12.5 in the standard instillation group. The amount of Midazolam, Fentanyl, and Diphenhydramine was not statistically significant between the two groups (p = 0.3951, p = 0.4919, p = 0.0664).
Lidocaine instillation via the spray catheter reduces the number of coughing episodes and amount of lidocaine compared to standard instillation during EBUS bronchoscopy.
The spray catheter is a useful tool for conscious sedation mediated EBUS bronchoscopy.
Hans Lee, No Financial Disclosure Information; No Product/Research Disclosure Information