Lidocaine 4% spray is better than intracuff lidocaine 2% for reducing the incidence of post-extubation cough in patients undergoing total abdominal hysterectomy

ABSTRACT

Cough at extubation and postoperative sore throat are common complications in patients receiving general anesthesia with trachea! intubation. Different strategies have been used to reduce these effects. In this double blind controlled trial, we evaluated the effects of lidocaine sprayed onto the larynx and injected into tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat in patients undergoing total abdominal hysterectomy [TAH] under general anesthesia. One hundred women, aged 40-60 years, scheduled for TAH under general anesthesia were included in this randomized double blind prospective study. After induction of general anesthesia, just before tracheal intubation, glottus was sprayed by 4% lidocaine or 0.9% saline through a syringe with 4 ml volume. After tracheal intubation, the tracheal tube cuff was filled with 4 ml of 2% lidocaine solution or 0.9% saline. In this way four groups were formed; spray-cuff group [lidocaine spray and lidocaine in cuff], spray-saline group [lidocaine spray and saline in cuff], saline-cuff group [saline spray and lidocaine in cuff], and saline-saline group [saline spray and saline in cuff], having 25 patients in each groups. The primary outcome was the incidence of cough at extubation. The incidence and severity of sore throat was recorded at 15 min, 60 min and 24 hrs post-extubation using visual analogue scale [VAS, 0=no pain, 10= worst pain imaginable] as a secondary outcome. All patients completed the study. Cough was noted in 20%, 16%, 76%, and 84% of patients in the spray-cuff group, spray-saline group, saline-cuff group and saline-saline group respectively. The spray of lidocaine onto the larynx resulted in decreased incidence of cough at extubation [P value < 0.001]. But the intracuff lidocaine did not show any decrease in the occurrence of cough or reduction in the incidence and severity of sore throat as it remained low in all groups. Use of lidocaine spray onto the larynx resulted in significantly decreased incidence of cough at tracheal extubation in patients undergoing TAH. However, the use of lidocaine into endotracheal tube cuffs had no effect on the incidence of cough or sore throat