Is Additional Nebulized Lidocaine Helpful in Flexible Bronchoscopy?: A Meta-Analysis. Issue 4 (October 2020)

• Record Type: Journal Article
• Authors: Ho, An Thi Nhat; Gandhiraj, Deepthi; Jamkhana, Zafar; Nayak, Ravi; Patolia, Setu
• Is Part Of: Journal of bronchology & interventional pulmonology. Volume 27:Issue 4(2020)
• Publication Date: 2020-10
• Subjects: nebulized lidocaine -- intrabronchial lidocaine -- bronchoscopy -- lidocaine -- local anesthesia; Bronchoscopy -- Periodicals; Lungs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Lung Diseases -- surgery -- Periodicals; Diagnostic Techniques, Respiratory System -- Periodicals; Bronchi; Bronchoscopy; Lungs -- Diseases; Periodicals; 616.23
• DOI: 10.1097/LBR.0000000000000656
• Languages: English
• ISSNs: 1944-6586

Abstract

Abstract : Background: Conflicting evidence of nebulized lidocaine use in bronchoscopy still exist. This study will identify whether there is any difference in various patient-related, physician-related, or procedure-related outcomes with and without lidocaine nebulization before the procedure. Method: The authors performed a search in 4 electronic databases, including Pubmed, Scopus, Virtual Health Library, and Google Scholar from inception to August 2019. Data on patient-reported and physician-reported outcomes, doses of sedation, and lidocaine were extracted and pooled into standardized mean difference (SMD) and mean difference (MD) using the random-effect model. Results: Seven randomized controlled trials with 1366 patients were included. Cough was not different between the nebulized lidocaine group and no nebulized lidocaine group (SMD, −0.12; 95% confidence interval, −0.82 to 0.59; I 2, 95%; P =0.75), so as operator's satisfaction score, ease of the procedure, patient's discomfort, and unwillingness to repeat the procedure. Additional nebulized lidocaine group required higher lidocaine dose (MD, 81.93; 95% confidence interval, 17.14-146.71). Studies using only local anesthesia favored the "no additional lidocaine" group in improving cough, operator's satisfaction score, and ease of the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam dose and duration of the procedure in the "additional nebulized lidocaine group." Conclusion: Additional administration of nebulized lidocaine increased the total dose of lidocaine used and did not improve cough symptoms, operator-satisfaction score, ease of the procedure, and willingness to repeat the procedure. Subgroup analysis of studies using moderate sedation showed a decrease in midazolam use and in procedure duration but the clinical significance of these findings is uncertain. Abstract : Supplemental Digital Content is available in the text.