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Utility of nasal application of lignocaine gel using cotton tip swab versus squirting with slip-tip syringe for transnasal fibreoptic bronchoscopy: a pilot randomised controlled trial
  1. Animesh Ray,
  2. Sagnik Biswas,
  3. Mouna B Manjunath,
  4. Ved Prakash Meena,
  5. Prayas Sethi,
  6. Sanjeev Sinha
  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Animesh Ray, Medicine, New Delhi 110029, India; doctoranimeshray{at}gmail.com

Abstract

Background During flexible fibreoptic bronchoscopy through the nasal route, anaesthesia of the nasal passage is achieved by lignocaine gel application by a slip-tip syringe or with the help of a cotton tip swab. No studies in existing literature have compared the two techniques in terms of efficacy.

Methods 137 consecutive patients undergoing bronchoalveolar lavage (BAL) were recruited over a 2-year period. The patients underwent BAL after nasal anaesthesia—either by slip-tip syringe or by cotton tip swab smeared with 2% lignocaine gel. Patients were monitored for intraprocedural epistaxis, discomfort and improvement in operator visibility of nasal passage.

Results 67 patients were randomised to cotton swab and 70 patients to the gel instillation group. There were no significant differences in terms of epistaxis, 29.9% in the cotton tip swab (95% CI 19.3% to 42.3%) versus 24.3% in the gel instillation group (95% CI 14.8% to 36%) or detection of nasal blocks, 7.5% in the cotton tip swab (95% CI 2.5% to 16.6%) versus 10% in the gel instillation group (95% CI 4.1% to 19.5%) in the two groups, although a significant difference was there in terms of visibility, 73.1% in the cotton tip swab (95% CI 60.9% to 83.2%) versus 42.9% in the gel instillation group (95% CI 31.1% to 55.3%). There was no difference in the mean pain score across the two groups either during the procedure or 1 hour after it. A short systematic review of existing literature on the topic has been provided for comparison.

Conclusion Application of 2% lignocaine gel by slip-tip syringe and cotton tip swab are equivalent in terms of observed and narrated pain experienced by patients, frequency of epistaxis and nasal blocks. Vision was better preserved in the cotton tip swab group.

  • bronchoscopy
  • anaesthetics
  • respiratory medicine (see thoracic medicine)

Data availability statement

Data are available upon reasonable request. All data relevant to the study findings will be provided on request to the corresponding author.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study findings will be provided on request to the corresponding author.

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Footnotes

  • Contributors AR, SB and MBM helped in collecting data, getting ethical approval and preparation of manuscript. PS, VPM and SS helped in editing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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