Comparison of nebulized and sprayed topical anaesthesia for fibreoptic bronchoscopy

We compared the efficacy of nebulized (N) and sprayed (S) topical anaesthesia prior to fibreoptic bronchoscopy in a blinded study involving 54 patients aged 57 +/- 26 yrs (mean +/- SD). Cough frequency, recorded on cassette tape, was the index of efficacy. All patients received 100 mg lignocaine sprayed into the pharynx, or nebulized in random order prior to bronchoscopy, and all received intravenous diazepam sedation. Each patient received a further 100 mg of lignocaine solution through the bronchoscope onto the vocal cords and major airways during the procedure. No significant difference was found in overall cough frequency between N and S groups (8.7 +/- 6.9 coughs.min-1 N vs 10.5 +/- 6.0 S), and cough frequency was also similar between N and S during the periods above and below the vocal cords. Furthermore, no differences were found in cough frequency between N and S among smokers, patients with asthma and COPD, and patients who had a biopsy procedure, although a trend was seen in all comparisons towards a lower cough frequency with the nebulized route. Most patients in the S group found the spray unpleasant, whereas only one in the N group complained. We conclude that nebulized and sprayed lignocaine have similar efficacy as topical anaesthetics in fibreoptic bronchoscopy, but patient preference favours the nebulized route.