Is Additional Nebulized Lidocaine Helpful in Flexible Bronchoscopy?: A Meta-Analysis

Area of Science:

• Pulmonology
• Anesthesiology

Background:

• Conflicting evidence exists regarding the efficacy of nebulized lidocaine in bronchoscopy.
• This study aimed to clarify outcomes associated with pre-procedure nebulized lidocaine.

Purpose of the Study:

• To evaluate the impact of nebulized lidocaine on patient-reported, physician-reported, and procedure-related outcomes during bronchoscopy.

Main Methods:

• A systematic literature search was conducted across four databases (PubMed, Scopus, Virtual Health Library, Google Scholar) up to August 2019.
• Data from seven randomized controlled trials involving 1366 patients were analyzed using random-effect models for pooled estimates (SMD and MD).

Main Results:

• Nebulized lidocaine did not significantly improve cough, operator satisfaction, ease of procedure, or patient willingness to repeat compared to no nebulization.
• The nebulized lidocaine group required a higher total lidocaine dose.
• In studies using only local anesthesia, omitting additional lidocaine improved outcomes. Subgroup analysis indicated reduced midazolam dose and procedure duration with nebulized lidocaine in moderate sedation settings.

Conclusions:

• Additional nebulized lidocaine increases total lidocaine consumption without demonstrable benefits in cough, satisfaction, or procedure ease.
• While moderate sedation subgroups showed reduced midazolam use and procedure duration, the clinical significance remains uncertain.