Use of lidocaine to prevent postoperative coughing after partial laryngectomy: comparison of three delivery methods

Objective: To compare the effectiveness of lidocaine administration (intravenous injection, dripping via the tracheostomy tube, and spraying into the tracheostomy incision) on postoperative coughing after partial laryngectomy. Patients and methods: A total of 115 male patients with laryngeal carcinoma scheduled for partial laryngectomy under general anesthesia were randomized into three groups. In group I (n=35), 2% lidocaine hydrochloride (1.5 mg/kg) was slowly infused intravenously. In group II (n=40), 2% lidocaine hydrochloride (1.5 mg/kg) was dripped into the tracheostomy tube upon completion of surgery. In group III (n=40), 7% lidocaine aerosol (5 sprays, 22.5mg) was sprayed into the tracheostomy incision before tracheostomy tube placement. We recorded incidences of coughing, incisional bleeding, and hemodynamic changes when leaving the postanesthesia care unit (T(1)), and 6 hrs (T(2)) and 24 hrs (T(3)) after surgery. Results: The coughing scores and incisional bleeding scores were significantly lower in group II and III than that in group I at T(1), T(2), and T(3). Group II and III had significantly lower heart rate than group I at T(1) and T(2). Compared with group I, mean arterial pressure decreased significantly in group II (T(1) and T(2)) and group III (T(1) and T(3)). Conclusion: In patients undergoing partial laryngectomy, spraying 7% lidocaine aerosol into the tracheostomy incision before placing the tracheostomy tube or instilling 2% lidocaine hydrochloride into the tracheostomy tube upon completion of surgery effectively prevented postoperative coughing, which reduced the risk of bleeding from the incision and thus facilitates postoperative rehabilitation.