Comparison of Preoperative Acupressure, Incentive Spirometry, and Nebulisation with Lignocaine in Reducing Fentany-induced Cough: A Randomised Controlled Study

Abstract

Introduction: Fentanyl bolus during induction often leads to cough. It is usually benign, but in some cases, it can be explosive and life-threatening. The incidence of Fentany-induced Cough (FIC) varies from 18% to 65%. Aim: To compare the effect of acupressure, incentive spirometry, and nebulisation with lignocaine on the incidence and severity of FIC. Materials and Methods: This single blind randomised controlled study was conducted in Department of Anaesthesia, Himalayan Institute of Medical Sciences, HIMS, Dehradun, Uttarakhand, India over a period of nine months from May 2019 to February 2020. Four hundred patients, aged 18-60 years, of either sex, scheduled for elective surgery, were randomly assigned to four groups: acupressure group (A), incentive spirometry group (S), nebulisation with lignocaine group (N), and control group (C). All patients received undiluted fentanyl at a dose of 2 mcg/kg over five seconds. Episodes of cough within 60 seconds of fentanyl administration were classified as FIC, and the severity was graded based on the number of coughs (mild: 1-2, moderate: 3-4, severe: 5 or more). The time of onset of FIC was recorded. Hemodynamic changes and adverse effects due to fentanyl injection and the procedure were noted. The Kruskal-Wallis test, Mann-Whitney U test, and Chi-square test were used for statistical analysis. Results: There were no differences among the four groups in terms of patients’ characteristics and a American Society of Anaesthesiologist (ASA) status. The incidence of FIC was higher in Group C (37%) compared to Group A (8%), S (12%), and N (10%), which was statistically significant (p-value<0.001). There was no significant difference in the incidence of FIC between Groups A, S, and N. Severe cough were observed in nine patients in the control group, one patient in the nebulisation and spirometry group, and none in the acupressure group. Conclusion: Non pharmacological methods such as acupressure and incentive spirometry were equally effective in reducing the incidence of FIC as the pharmacological methods and are more cost effective.