Anestesia e Pesquisa Clínica
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Does the Use of Topical Lignocaine Spray during Microlaryngeal Surgery Under General Anaesthesia have Significant Clinical Benefit? - A Prospective Double-Blind Randomized Placebo-Controlled Trial

Montague ML, Vernham GA, Todd G and MacKenzie K

Objective: To determine if topical lignocaine used during microlaryngeal surgery under general anaesthesia confers significant clinical benefit by reducing the pressor response and laryngospasm that often occur during recovery.

Study Design: Prospective double-blind randomised placebo-controlled trial in a UK Otolaryngology department. 85 patients undergoing elective microlaryngeal surgery receiving either 4 ml 4% lignocaine spray to the vocal cords and piriform fossae or 4 ml 0.9% saline spray to the same areas at induction of anaesthesia.

Methods: Primary outcome measures were pulse and blood pressure recorded immediately before spray application and at 5 minute intervals during recovery for 20 minutes and the degree of laryngospasm or cough (absent, mild, moderate, severe) recorded at the same intervals. Secondary outcome measures included patient grading of post-operative throat discomfort on a visual analogue scale (1 to 100 mm) and analgesia requirements in the first 6 hours post-operatively.

Results: 44 patients (mean age 58 years, 22 male, 22 female) were randomised to receive lignocaine and 41 patients (mean age 57 years, 24 male, 17 female) saline spray. No statistically significant difference was found between groups in mean pulse or mean systolic and diastolic blood pressure immediately before application of spray or during the recovery period. There was no difference in the degree of post-operative coughing or laryngospasm or analgesia requirements between the groups. Topical lignocaine was associated with more throat discomfort than saline (p=0.03; Diff 0.9; 95% C.I. 0.1 to 1.8).

Conclusion: The use of topical lignocaine spray conferred no clinical benefit in this study.