Bilateral Superior Laryngeal Nerve Block to Attenuate the Pressor Response of Laryngoscopy and Intubation in Adult Patients Undergoing Elective Surgeries Under General Endotracheal Anesthesia: A Randomized Controlled Double-blind Study.

BACKGROUND

Laryngoscopy and endotracheal intubation are essential for airway management but provoke a transient pressor response characterized by hypertension and tachycardia. This reflex sympathetic stimulation can pose significant risks to patients with cardiovascular comorbidities.

OBJECTIVES

To evaluate the efficacy of ultrasound-guided bilateral superior laryngeal nerve block (SLNB) using 2% lidocaine in attenuating hemodynamic responses and reducing postoperative airway complications during elective surgeries under general anesthesia.

METHODOLOGY: This randomized double-blind controlled study included 234 adult patients aged 18-60 years with American Society of Anesthesiologists I and II physical status, divided into Group-L (lidocaine, n = 117) and Group-N (normal saline, n = 117). Hemodynamic parameters-heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)-were recorded at baseline, postinduction, and at defined intervals postlaryngoscopy and intubation. Postextubation complications, including cough, hoarseness, and sore throat, were assessed at 0, 2, 6, and 24 h.

RESULTS

Group-L showed significantly attenuated HR, SBP, DBP, and MAP compared to Group-N ( P < 0.001 at all-time points). Postoperative airway complications were significantly lower in Group-L immediately postextubation ( P < 0.05) but comparable between groups at 6 and 24 h.

CONCLUSIONS

Ultrasound-guided SLNB effectively attenuates the pressor response to laryngoscopy and intubation and reduces immediate postoperative airway complications. This technique offers a safe and effective strategy for haemodynamic stability in perioperative care.