The Influence of Piriform Recess Instillation with Lidocaine Before Bronchoscopy on Post-General Anesthesia Cough: A Randomized Controlled Trial

Abstract

Background and Importance

Postoperative cough is a common complication of general anesthesia after bronchoscopy. The aim of the present study was to determine the safety profile and efficacy of piriform recess instillation with lidocaine in reducing the incidence of coughing.

Objective

To what extent could piriform recess instillation with lidocaine decrease the incidence of cough at 10min after extubation?

Outcome Measures and Analysis

Eighty-eight consecutive patients were equally randomized to a lidocaine group receiving piriform recess instillation with 2mL 2% lidocaine, and a normal saline group receiving piriform recess instillation with 2mL saline. The primary outcome was the incidence of cough after extubation, and the secondary outcomes were throat score at 10 min and 6 h after extubation assessed by the numerical rating scale, cough severity at 10 min and 6 h after extubation assessed by the Visual Analog Scale (VAS), 24 h 40-item Quality of Recovery Score (QoR-40), and subject-rated satisfaction score on a VAS.

Main Results

Compared with saline group, the incidence of cough in lidocaine group was significantly lower (63.6% vs 86.4%, P=0.014). The sore throat score at 10 min after extubation was significantly lower (0[0,0] vs 1[0,2], P<0.001). The subject-rated overall anesthesia satisfaction score was significantly higher (84.8[±6.2] vs 76.6[±8.6], P<0.001). The severity of cough at 10 min after extubation was significantly lower (Mild: 36.4% vs 11.4%, P=0.006; Severe: 9.1% vs 43.2%, P<0.001). There was no significant difference in the sore throat score at 6 h after extubation, severity of cough at 6 h after extubation, or QoR-40 at 24 h after extubation between the two groups.

Conclusion

Piriform recess instillation with lidocaine before bronchoscopy is a simple and effective method for reducing early cough intensity and alleviating early sore throat. At 6 hours, there were no differences observed between the groups.

Clinical Trial Registration

Chinese Clinical Trial Registry (identifier: ChiCTR2200067087).

Keywords:

• piriform recess
• lidocaine
• general anesthesia
• cough
• bronchoscopy

Abbreviations

ASA = American Society of Anesthesiologists; BAL = Bronchoalveolar Lavage; BMI, Body Mass Index; COPD = Chronic Obstructive Pulmonary Disease; EBB = Endobronchial Biopsy; EBUS-TBNA=Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration; IQR = Interquartile Range; iSLN = Internal Superior Laryngeal Nerve; NRS = Numerical Rating Scale; POST = Postoperative Sore Throat; SD = Standard Deviation; SLN = Superior Laryngeal Nerve; TRPV1 = Transient Receptor Potential Vanilloid Type-1; TRPA1 = Transient Receptor Potential Ankyrin-1; VAS = Visual Analog Scale; Vgscs=Voltage-Gated Sodium Channels.

Guarantor Statement

X. L takes responsibility for the content of the manuscript, including the data and analysis.

Data Sharing Statement

All data generated or analyzed during this study have been included in the published article. For further inquiries regarding the datasets, they are available from Xin Lv upon request.

Acknowledgments

Thanks for the assistance from the laboratory mentors and colleagues in this work.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by the Program of Shanghai Academic Research Leader [grant number 21XD1402800]; Development Fund for the Department of Anesthesiology, Shanghai Pulmonary Hospital; Key Disciplines Supported by the Shanghai Municipal Public Health System [grant number 2023ZDFC02040]. Talent Programme of Shanghai Pulmonary Hospital [grant number fkxr1909] Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript. Other contributions: The authors gratefully acknowledge all the participants in this trial.