Comparison between lignocaine nebulization and airway nerve blocks for awake fiberoptic nasotracheal intubation in oral cancer surgery patients: Running title: Airway management in oral cancer patients

Abstract

Intro duction: Awake fiberoptic bronchoscope-guided intubation is the preferred airway management strategy in a patient with a difficult airway and limited mouth opening. The aim is to compare the efficacy of nebulization and airway nerve block using lignocaine to provide airway anesthesia in awake patients using fiberoptic bronchoscope for nasal intubation to make the patient comfortable, cooperative, and agreeable. Methods: In this randomized, prospective, single-blinded study, sixty adult patients scheduled for oral cancer surgeries were divided into two equal groups. Nebulization with 4% lignocaine (10 ml) was performed in Group N, and superior bilateral laryngeal and trans-laryngeal recurrent laryngeal nerve blocks used 2% lignocaine (2 ml) were given in Group B. Nasotracheal intubation using fiberoptic bronchoscope were performed. Intravenous midazolam and fentanyl were used for sedation and analgesia. We recorded the ease of intubation, coughing episodes, vocal cord status, hemodynamic variables, patient recall, and lignocaine toxicity. Student's t-test and Chi-square tests were used for appropriate data. Statistical significance was considered for P < 0.05 (SPSS Version 20, IBM, USA). Results: The intubation time was shorter with better intubating conditions in Group B (120.3 ± 42.6 s) than Group N (200.4 ± 60.3 s) (P < 0.001). Cough severity and patient recall for untoward effects were lower in Group B. Intubation were done successfully in all patients. Conclusion: Airway nerve blocks provided better airway anesthesia characterized by easier fiberoptic intubation and patient comfort than lignocaine nebulization. Nebulization can be considered a suitable alternative when nerve blocks are not feasible due to distorted neck anatomy.