Upper Airway Block Using Lidocaine Nebulisation Versus Targeted Nerve Block for Awake Fibre-Optic Intubation in Patients with Head and Neck Burns: A Randomised Controlled Trial

Background: A difficult airway is a scenario in which an adequately trained anesthesiologist faces challenges with mask ventilation, endotracheal intubation, or both. Various anesthetic techniques have been proposed to prepare adequately for awake flexible fiber-optic intubation (AFOI), including nerve blocks for the upper airway, topical anesthesia via a specialized cannula, and lidocaine nebulization (LN). Proper anesthesia of the upper airway is crucial for successful AFOI. Objectives: This study aimed to evaluate the efficacy of airway block (AB) by LN compared to traditional upper AB techniques. Methods: This prospective, randomized, single-blinded study was conducted on 100 patients with head and neck burns scheduled for reconstructive surgery. Participants were randomly assigned to two groups of 50 patients each. In the AB group, AFOI was performed following an AB, while in the LN group, AFOI was performed 30 minutes after LN. The primary outcome measured was the time to successful awake nasal fiber-optic intubation. Secondary outcomes included the number of failed attempts and the revised nonverbal pain scale score. The time to successful awake nasal fiber-optic intubation showed no significant difference between the two groups. Results: Although the AB group had a higher number of failed attempts compared to the LN group, statistical analysis revealed no significant difference. Additionally, there was no significant difference in hemodynamic parameters between the groups. Conclusions: Both AB and LN are effective for awake nasal fiber-optic intubation, with comparable intubation times. However, LN offers a less invasive alternative.