COMPARISON OF THE EFFICACY OF INTRAVENOUS LIGNOCAINE WITH COMPOUND LIDOCAINE/PRILOCAINE CREAM IN PREVENTING POST EXTUBATION COUGH IN PATIENTS UNDERGOING GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROL TRIAL

Abstract

Background Post-extubation cough is a frequent complication following general anaesthesia, occurring in up to 60% of patients and often leading to discomfort, delayed recovery, and postoperative complications such as wound disruption or cardiovascular stress. Strategies including intravenous lignocaine and topical anaesthetics have been employed to mitigate this complication, yet their comparative effectiveness remains uncertain. Given the clinical impact of airway irritation on patient recovery, identifying the most effective preventive measure is essential.

Objective: To evaluate and compare the effectiveness of intravenous lignocaine with topical compound lidocaine/prilocaine cream in reducing the incidence of post-extubation cough in patients undergoing laparoscopic cholecystectomy.

Methods: A randomized controlled trial was conducted at the Department of Anaesthesia, Mayo Hospital, Lahore, over six months. Seventy-two patients aged 18–60 years, classified as ASA I–II, and scheduled for laparoscopic cholecystectomy under general anaesthesia were enrolled and randomly assigned into two groups using computer-generated randomization. Group A received intravenous lignocaine 2% at a dose of 1.5 mg/kg 1.5 minutes before extubation, while Group B had 2 g lidocaine/prilocaine cream (5%) applied evenly on the endotracheal tube cuff at intubation. Standardized anaesthesia protocols were followed. The primary outcome was the absence of post-extubation cough observed within two hours postoperatively. Data were analyzed using SPSS version 23, with chi-square tests applied for group comparisons, considering p ≤ 0.05 statistically significant.

Results: Efficacy in preventing post-extubation cough was significantly higher in Group B compared to Group A (66.7% vs. 38.9%, p = 0.01). Subgroup analysis showed superior outcomes in Group B among females (71.4% vs. 28.6%, p = 0.008), ASA I patients (57.1% vs. 42.9%), ASA II patients (80.0% vs. 20.0%, p = 0.05), patients with BMI ≥25 kg/m² (65.6% vs. 34.4%, p = 0.006), and surgeries lasting <90 minutes (61.5% vs. 38.5%, p = 0.03).

Conclusion: Topical lidocaine/prilocaine cream demonstrated superior efficacy compared with intravenous lignocaine in preventing post-extubation cough, offering a simple and effective intervention to improve patient comfort and postoperative recovery in laparoscopic cholecystectomy.