A RANDOMIZED CONTROLLED TRIAL COMPARING EFFICACY OF INTRACUFF 0.5% ALKALINIZED LIGNOCAINE, 0.5% LIGNOCAINE AND SALINE ON ENDOTRACHEAL TUBE INDUCED LARYNGOTRACHEAL MORBIDITY IN CHILDREN

Pallavi B, Vandana Talwar, Viswesvaran Balasubramanian, Abhijeet Singh

Abstract


Background and Objectives: Postoperative laryngotracheal (LT) morbidity remains a common problem despite ongoing advances. There is a paucity of studies in children comparing the incidence of postoperative LT morbidity after instillation of endotracheal tube (ETT) cuff with 0.5% alkalinized lignocaine, lignocaine and saline. Therefore, the current study was undertaken to compare the efficacy of intracuff 0.5% alkalinized lignocaine, 0.5% lignocaine and saline in reducing the incidence of postoperative LT morbidity. 

Material and Methods: A prospective randomized controlled trial was conducted involving 120 pediatric patients aged between 5 – 12 years of American Society of Anaesthesiologists (ASA) grade I and II, undergoing elective surgery. Patients were randomized into three groups - Group S (n=40), Group L (n=40) and Group AL (n=40) on the basis of inflation of ETT cuff with saline, 0.5% lignocaine (0.5 ml of 2% lignocaine + 7.5 ml of normal saline) and 0.5% alkalinized lignocaine (2.5 ml of 2% lignocaine +7.5ml of normal saline followed by disposal of 0.5 ml mixed solution + 0.5% of 7.5% NaHCO3)respectively. Inflation was performed until a cuff pressure of 20-30 cm H20 was achieved. Postoperatively cough, sore throat, dysphonia, dysphagia, pain and nausea and vomiting were noted at 1, 8 and 24 hours.

Results

Demographic variables were comparable in all the three groups in terms of age, sex, weight and height. Intra cuff instillation of alkalinized lignocaine resulted in an increased incidence of smooth extubation in comparison to lignocaine and saline (p=0.001), with lignocaine being significantly better than saline. (p=0.001) It was noted that intra cuff instillation of alkalinized lignocaine was significantly better than lignocaine which was significantly better than saline in terms of reduction in the incidence of post extubation cough and sore throat at 1 and 8 hours and dysphonia at 1 hour after extubation. (p=0.001) Alkalinized lignocaine and lignocaine were significantly better than saline in the reduction of bronchospasm, laryngospasm and bucking, cough and sore throat at 24 hours and dysphonia at 8 and 24 hours after extubation but no difference was found between Group AL and L. No differences were observed among three groups regarding incidence of dysphagia, nausea / vomiting and pain at 1 hour, 8 hours and 24 hours following extubation.

CONCLUSION & RECOMMENDATION

Intracuff instillation of alkalinized lignocaine can be recommended in children aged 5 – 12 years for decreasing the incidence of laryngotracheal comorbidities.


Keywords


Alkalinized lignocaine; Bronchospasm; Cough; Dysphonia; Laryngotracheal morbidity; Lignocaine; Sore throat

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