Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study

Abstract

Background: The airway reflex such as cough is common accompanied with severe fluctuations of hemodynamics during emergence. This prospective double-blind randomized controlled trial tested the hypothesis that topical ropivacaine may reduce extubation response and postoperative sore throat.

Methods: Fifty-four patients undergoing thyroidectomy were randomly assigned to two groups. The patients in Group R were received 0.75% ropivacaine, which was sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis to achieve uniform surface anesthesia. As control, patients in Group C were received the same volume saline. The primiary outcome was the incidence and grade of cough during peri-extubation.

Results: The incidence (34.62% vs. 76.92%, P = 0.002) of cough during extubation were lower in Group R compared to Group C. Meanwhile, the sore throat visual acuity score at 12 h after surgery was lower in Group R than that in Group C (2.00 vs. 3.50, P = 0.040).

Conclusion: Topical anesthesia with 0.75% ropivacaine before intubation can significantly reduce the incidence of cough during peri-extubation. Meanwhile, it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery.

Trial registration: Chinese Clinical Trial Registry, ChiCTR1800014412 (date of registration January 2018).

Keywords: Ropivacaine; Anesthesia; Local; Anesthesia Recovery Period; Anesthesia and Analgesia; cough.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the ethics committee of the First Affiliated Hospital of Anhui Medical University on December 29, 2017(approval number:PJ2017-12-13) and written informed consents have been obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Consort flow chart that outline patients assignment and treatment protocols. Group R: the patients were recieved 6 ml of 0.75% ropivacaine for throat, glottic area and tracheal mucosa uniform spray; Group C: the patients were recieved with 6 ml of saline for throat, glottic area and tracheal mucosa uniform spray as control

Fig. 2

Incision pain scores (VAS). Data are presented as median (range). Group R: the patients were recieved 6 ml of 0.75% ropivacaine for throat, glottic area and tracheal mucosa uniform spray; Group C: the patients were recieved with 6 ml of saline for throat, glottic area and tracheal mucosa uniform spray as control.*P < 0.05 compared with group C

Fig. 3

Hemodynamic values. a: MAP; b: HR. Data are presented as mean ± standard deviation Group R: the patients were recieved 6 ml of 0.75% ropivacaine for throat, glottic area and tracheal mucosa uniform spray; Group C: the patients were recieved with 6 ml of saline for throat, glottic area and tracheal mucosa uniform spray as control. HR = heart rate (beats/min); MAP = mean arterial blood pressure (mmHg); T0 = baseline (before anesthesia induction); T1 = before intubation; T2 = intubation immediately; T3 = 5 min after intubation; T4 = end of surgery; T5 = extubation immediately; T6 = 5 min after extubation. #P < 0.05 compared with group C. (MAP:T5#P = 0.001, MAP:T6#P = 0.002, HR:T2#P = 0.000, HR:T3#P = 0.023, HR:T5#P = 0.011, HR:T6#P = 0.004)