Sedative and Local Anaesthetic Requirements During EBUS-TBNA with Airway Nerve Blocks: A Prospective Observational Study

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure used for diagnosing mediastinal and lung pathologies. Due to the size of the EBUS bronchoscope and multiple needle passes, patient discomfort is common, often requiring deep sedation or general anesthesia. Airway nerve blocks may reduce sedative and local anesthetic requirements while suppressing cough, but limited data exist on their efficacy.

Objective: To evaluate sedative and lignocaine requirements during EBUS-TBNA when airway nerve blocks are used and to assess cough suppression, procedure interruptions, complications, and operator satisfaction.

Methods: This prospective, single-center observational study included 62 patients aged over 18 years undergoing EBUS-TBNA at M S Ramaiah Hospital. All patients received bilateral superior laryngeal nerve blocks and transtracheal lignocaine instillation. Sedation with propofol and additional lignocaine sprays were administered as needed. Primary outcomes were cumulative propofol and lignocaine doses. Secondary outcomes included cough count, intubation time, procedure duration, operator-rated Likert score, complications, and procedure interruptions. Correlation between cough count and anesthetic requirements was analyzed.

Results: The mean age of participants was 59 ± 12 years. Median cough count was 1 (IQR 0–3). Mean cumulative lignocaine and propofol doses were 35 ± 10 mg and 85 ± 100 mg, respectively. Mean intubation time was 55 ± 20 seconds, and mean procedure duration was 75 ± 25 minutes. Median operator Likert score was 4 (IQR 3–4). Complications occurred in 12 patients (15%), and interruptions were noted in 18 patients (22%). Cough count showed a positive correlation with lignocaine (r = 0.45, p < 0.01) and propofol doses (r = 0.52, p < 0.01). Complications were significantly associated with procedural interruptions (χ² = 6.5, p = 0.01).

Conclusion: Airway nerve blocks during EBUS-TBNA effectively reduce sedative and local anesthetic requirements, suppress cough, and allow operators to perform procedures with minimal interruptions and high satisfaction. These findings support the routine use of airway blocks to improve patient comfort and procedural safety during EBUS-TBNA.