Nebulized lidocaine for flexible bronchoscopy - A randomized, double-blind, placebo-controlled trial

Objective: Topical anesthesia for flexible bronchoscopy can he administered via transericoid injection, nebulizer, or directly through the bronchoscope in a "spray as you go" fashion. We performed a prospective, randomized, double-blind, placebo-controlled trial to evaluate whether nebulized lidocaine provides additional benefit and reduces the total anesthetic dose required during bronchoscopy. Setting: Tertiary, care university hospital. Methods: one hundred fifty,patients (93 men; age, 20 to 89 years) undergoing diagnostic flexible bronchoscopy were randomized to receive either 4 mL of 4% lidocaine (160 mg) or 4 mL of saline solution as placebo via nebulization. Combined sedation was achieved using 5 mg of IV hydrocodone and midazolam boluses. Supplemental lidocaine closes and total midazolam required as judged by the bronchoscopist were recorded for each patient. After the procedure, both bronchoscopists and patients charted their perception of cough on a 10-cm visual analog scale WAS). Similarly, patients recorded their discomfort related to the procedure on a 10-cm VAS. Results: The most common procedures were BAL in 77 cases (51%), transbrouchial biopsy in 40 cases (27%), and transbronchial needle aspiration in 34 cases (23%). Outcome parameters, including hemodynamic findings, duration of the procedure, cough scores for physicians and patients, discomfort score for patients, midazolam doses,and supplemental lidocaine doses, were similar in both groups. Mean total lidocaine dose required in the lidocaine group was 318 +/- 41 mg and was significantly higher than the total (lose required in the placebo group (157 +/- 44 mg [+/- SD]) [p < 0.001]. Conclusion: Additional nebulized lidocaine cannot be recommended for flexible bronchoscopy performed under combined sedation.