Comparing the Efficacy of “Spray as You Go” Technique Versus Combined Airway Nerve Block and “Spray as You Go” as Topical Anesthesia During Flexible Bronchoscopy; a Double-Blinded Randomized Clinical Trial

Effat Rafiee; Omalbanin Paknejad; Negar Eftekhar; Oveis Salehi; Parisa Rashidi; Marsa Gholamzadeh; Mehrnaz Asadi Gharabaghi

doi:10.18502/acta.v61i12.16370

Effat Rafiee Department of Pulmonary Medicine, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Omalbanin Paknejad Department of Pulmonary Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Negar Eftekhar Department of Anesthesiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Oveis Salehi Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Parisa Rashidi Department of Medicine, Nezam Mafi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Marsa Gholamzadeh Department of Medical Informatics, School of Medical Informatics, Tehran University of Medical Sciences, Tehran, Iran
Mehrnaz Asadi Gharabaghi Department of Pulmonary Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v61i12.16370

Keywords: Bronchoscopy; Local anesthesia; Lidocaine; Airway nerve block

Abstract

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P<0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications.