Efficacy and Safety of Double-Cuff Endotracheal Tube Lidocaine Injection for Preventing Extubation-Related Coughing in Neurosurgical Patients: A Randomized Trial

Background The incidence of coughing is high during extubation following general anesthesia with endotracheal intubation. For intracranial surgery, cough is an important factor affecting cerebral blood flow and intracranial pressure. This study aimed to evaluate the efficacy and safety of lidocaine delivered via a double-cuff endotracheal tube to prevent extubation-related coughing in neurosurgical patients, and to compare two administration techniques. Methods This randomized, double-blind, controlled trial included 147 patients scheduled for elective neurosurgery. The study drug was administered via the double-cuff endotracheal tube five minutes after admission to the post-anesthesia care unit (PACU). We randomized patients into Groups A (above-cuff injection), Group B (below-cuff injection), and Group C (control), 49 patients each. The primary outcome measure was the incidence of moderate-to-severe coughing. Secondary Outcomes Secondary outcomes included total cough incidence, propofol use, postoperative recovery parameters, incidence of extubation-related complications and adverse events, and visual analogue scale (VAS) scores at 1 hour and 24 hours. Results Group A demonstrated a significantly lower incidence of moderate-to-severe coughing during extubation compared to Groups B and C (P < 0.05). The total incidence of coughing was also significantly lower in Group A compared to Group C, and in Group B compared to Group C (P < 0.05). There was a significant group×time interaction for heart rate and mean arterial pressure, with Groups A and B exhibiting smaller fluctuations than Group C. At 1 h, Group A had the lowest VAS sore-throat scores (P < 0.001). Conclusion Lidocaine injection above and below the cuffs of a double-cuff tube during neurosurgical extubation significantly reduces coughing incidence, with the above-cuff technique yielding the greatest benefit. Trial registration ChiCTR2100049708, 08/08/2021, https//www.chictr.org.cn.