Intravenous Lidocaine Suppresses Fentanyl-Induced Coughing: A Double-Blind, Prospective, Randomized Placebo-Controlled Study

Abstract

IV lidocaine is effective in suppressing the cough reflex of tracheal intubation, extubation, bronchography, bronchoscopy, and laryngoscopy. We investigated this effect of lidocaine on fentanyl-induced cough in 502 patients of ASA physical status I and II scheduled for elective surgery. The patients were assigned to 2 equal groups to receive either lidocaine 1.5 mg/kg or placebo (0.9% saline) over 5 s 1 min before the administration of fentanyl 3 mug/kg in a randomized and double-blind fashion. Coughs were classified as coughing and graded as mild (1-2), moderate (3-4), or severe (5 or more). The results of the study suggest that IV lidocaine 1.5 mg/kg, when administered 1 min before fentanyl, is significantly effective in suppressing fentanyl-induced cough compared to placebo (0.9% saline) (218 versus 165 patients) (P < 0.002) but without affecting the severity of cough (P > 0.05).

Intravenous lidocaine 0.5 mg·kg-1 effectively suppresses fentanyl-induced cough

“…[8][9][10] In a placebo-controlled clinical study it has been demonstrated that lidocaine 1.5 mg·kg -1 decreased fentanyl-induced cough from 34.22% to 13.14% (absolute risk reduction was 21.08% and relative risk reduction was 62%) one minute prior to fentanyl administration. 11 We evaluated the minimal dose of lidocaine for suppression of fentanyl-induced cough in this randomized, prospective and placebo-controlled study.…”

“…Considering the incidence of coughing following peripherally administered iv fentanyl is 30%, and assuming a reduction of 20% (assumption based on the results of a previous clinical investigation) 11 at the 5% level of significance and 80% confidence of detecting a true difference following lidocaine treatment, a minimum of 79 patients was required in each group. After completion of the study, the treatment groups were decoded and the data were entered into the statistical software package SPSS 9.0 (Chicago, IL, USA).…”

“…Lidocaine 1.5 mg·kg -1 administered one minute prior to fentanyl significantly reduced the incidence of cough from 34.22% to 13.14% (absolute risk reduction of 21.08% and relative risk reduction of 62%). 11 In the present study we used increasing doses of lidocaine to evaluate its suppressive effect on fentanylinduced cough. The results demonstrate that all doses reduced the incidence of cough, but that there is no significant difference between treatment groups.…”

No relationship between the incidence of fentanyl-induced cough and smoking

“…We have shown in ASA I-III nonsmoking European patients that the incidence of cough after 1.5 g . kg -1 fentanyl is around 4% and not related to the speed of injection [1], much lower than previously assumed [2][3][4][5][6][7][8][9].…”

Can Calcium and Sodium Channel Blockers Attenuate Hemodynamic Responses to Endotracheal Intubation?

“…The results of various studies, in the last decade, on the effect of hemodynamic responses to tracheal induction have varied considerably. Many studies have reported beneficial effect (29)(30)(31)(32)(33), while others showed no effect (5, [34][35][36]. The difference in the results of various studies involving lidocaine, to some extent, can be explained by differences in study designs including variations in patient population, age, and dose and timing of drug administration in relation to intubation (37).…”