Airway nerve blocks as an adjunct to lignocaine nebulization for awake fiberoptic intubation

Abstract

ABSTRACT Background Awake tracheal intubation (ATI) is becoming a gold standard in managing the difficult airway. Airway anesthesia is the cornerstone for the preparation of awake fiberoptic intubation (AFOI). Many topical and regional techniques have been developed to attenuate airway reflexes and facilitate AFOI. Glossopharyngeal superior laryngeal and recurrent laryngeal nerves must be blocked to attain adequate reflex abolishment. Aim This randomized controlled prospective study was performed to evaluate the effectiveness of adding airway nerve blocks to lignocaine nebulization for nasal AFOI. Methodology This was a comparative study conducted in 50 patients randomly allocated into two groups of 25 each: Group A and Group B; both received nebulization of 2% lignocaine 10 mL. Group B was then given airway blocks as bilateral superior laryngeal (2% lignocaine 1.5 mL each) and transtracheal (2% lignocaine 2 mL) block. Group A received the same airway nerve block by the same volume with normal saline 0.9%. Two puffs of 10% lignocaine to the nose and postnasal space on each side were given to both groups. Awake nasal fiberoptic intubation was performed. Vital parameters, such as intubation time, intubation condition, patient comfort scale, satisfaction score, and side effects, were recorded. Statistical analysis for both groups was done. Results Statistically, no significant differences were found in demographics and hemodynamics. Regarding intubation time and intubation condition scale, there was a significant improvement in Group B than in Group A. Also, overall patient comfort and satisfaction scores were significantly better in Group B than in Group A. Conclusion Upper airway lignocaine nebulization may provide adequate anesthesia for AFOI, but when supplemented by airway nerve blocks, it improves the quality of anesthesia and patient satisfaction.