Comparison of intravenous nabuphine and dexmedetomidine in combination with lidocaine aerosol inhalation in awake direct laryngoscopy: a randomized, double-blind, placebo-controlled trial

Abstract

Abstract Background: The airway should be thoroughly and accurately evaluated before anesthesia induction and endotracheal intubation. The awake direct laryngoscopy(ADL) is an important tool for assessing airway especially difficult airway, sometimes eliminates the need for fiberoptic intubation in some suspicious difficult airway cases. However, an optimal regimen has not been determined. Aims: This study aimed to assess and compare the tolerance, satisfaction and safety of nalbuphine and dexmedetomidine combined with lidocaine for ADL. Methods: In this double-blind, controlled study, prior to ADL, 60 patients scheduled for general anesthesia were randomly allocatedto receive 0.75μg/kg of Dex (Dex group, n = 20), 0.15 mg/kg of nalbuphine (Nal group, n = 20), or a placebo (control group, n = 20) intravenously for 10 minutes. At the same time, all study subjects received atomized lidocaine for 15 minutes.The primary outcome was patient tolerance as assessed by a 5-point ADL comfort score, while secondary outcomes included satisfaction, coughing, pain, nausea and vital signs. Results: Patients undergoing ADL in the Nal group had higher tolerance scores than those in the control and Dex groups (P<0.01 andP<0.001, respectively) andhigher satisfaction (P<0.01 andP<0.001, respectively). Additionally, the Nal group had significantly fewer adverse events, such as nausea, coughing, and pain, than the control and Dex groups. The sedation score and peripheral oxygen and saturation was significantly higher in the Nal group than in the Dex group, with no difference between the Nal and control groups (P< 0.001, P =0.159, respectively). Conclusions: Intravenous nabuphine in combination with lidocaine aerosol inhalation significantly improved patient tolerance and satisfaction while reducing nausea, coughing, pain, sedation and hypoxemia during ADL. Trial registration: ChiCTR2200062116, 23/07/2022.