BACKGROUND AND AIM The optimal mode of delivering topical anesthesia during flexible bronchoscopy remains unknown. Herein, we compare the efficacy and safety of nebulized lignocaine, lignocaine oropharyngeal spray, or their combination. METHODS Consecutive subjects were randomized 1:1:1 to receive nebulized lignocaine (2.5 mL of 4% solution, group A), oropharyngeal spray (10 actuations of 10% lignocaine, group B), or nebulization (2.5 mL, 4% lignocaine) and two actuations of 10% lignocaine spray (group C). The primary outcome was the subject-rated severity of cough, using the visual analogue scale (VAS). The secondary outcomes included bronchoscopist-rated severity of cough and overall procedural satisfaction on VAS, total lignocaine dose, subject's willingness for a repeat procedure, adverse reactions to lignocaine, and others. RESULTS We included 1050 subjects (median age 51 years, 64.8% men). The median (interquartile range [IQR]) score for subject-rated cough severity was significantly lower in group B vs. group C and group A (4 [1-10] vs. 11 [4-24] and 13 [5-30], respectively, p<0.001). The bronchoscopist-rated severity of cough was also the least (p<0.001), and the overall satisfaction highest in group B (p<0.001). The cumulative lignocaine dose administered was the least in group B (p<0.001). A significantly higher proportion of subjects (p<0.001) were willing for a repeat bronchoscopy in group B (73.7%) than groups A (49.1%) and C (59.4%). No lignocaine-related adverse events were observed. CONCLUSION Ten actuations of 10% lignocaine oropharyngeal spray was superior to nebulized lignocaine or their combination, for topical anesthesia during diagnostic flexible bronchoscopy.

中文翻译：

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雾化利多卡因、利多卡因喷雾剂或它们的组合在诊断性软支气管镜检查期间用于局部麻醉的随机试验

背景和目的 在软性支气管镜检查期间实施局部麻醉的最佳模式仍然未知。在此，我们比较了利多卡因雾化、利多卡因口咽喷雾剂或其组合的疗效和安全性。方法 连续受试者以 1:1:1 的比例随机接受雾化利多卡因（2.5 mL 的 4% 溶液，A 组）、口咽喷雾（10% 利多卡因的 10 次驱动，B 组）或雾化（2.5 mL，4% 利多卡因）和两次 10% 利多卡因喷雾（C 组）。主要结果是受试者使用视觉模拟量表 (VAS) 评定的咳嗽严重程度。次要结果包括支气管镜医师评定的咳嗽严重程度和对 VAS 的总体程序满意度、利多卡因总剂量、受试者重复手术的意愿、对利多卡因的不良反应等。结果 我们纳入了 1050 名受试者（中位年龄 51 岁，男性占 64.8%）。B 组与 C 组和 A 组相比，受试者评定的咳嗽严重程度的中位数（四分位距 [IQR]）得分显着较低（4 [1-10] 与 11 [4-24] 和 13 [5-30] ]，分别为 p<0.001）。支气管镜医师评定的咳嗽严重程度也是最低的（p<0.001），而 B 组的总体满意度最高（p<0.001）。给予的累积利多卡因剂量在 B 组中最少（p<0.001）。与 A 组 (49.1%) 和 C (59.4%) 相比，B 组 (73.7%) 中愿意进行重复支气管镜检查的受试者比例显着更高 (p<0.001)。未观察到与利多卡因相关的不良事件。结论 10% 利多卡因口咽喷雾的 10 次启动优于雾化利多卡因或其组合，