Topical lignocaine anaesthesia for oropharyngeal sampling for COVID-19
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MISCELLANEOUS
Topical lignocaine anaesthesia for oropharyngeal sampling for COVID‑19 Anupam Kanodia1 · Deepankar Srigyan2 · Kapil Sikka1 · Aashish Choudhary2 · Avinash Choudekar2 · Saurabh Mittal3 · Shweta Arun Bhopale4 · Lalit Dar2 · Alok Thakar1 Received: 26 August 2020 / Accepted: 23 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To ascertain if topical lignocaine application in oropharynx prior to swab sampling to test for COVID-19 improves a patient’s comfort and to assess its effect on the swab sample taken to conduct the RT-PCR. Methods Adult patients testing positive on the RT-PCR COVID-19 test were sampled again within 48 h after administering topical oropharyngeal anaesthesia. Patients were asked to rate their discomfort on a visual analog scale (VAS) for both sample A and B. A qualitative real-time RT-PCR for detection of SARS-CoV-2 RNA, was performed, and the cycle threshold value (Ct), used as a surrogate marker for the viral load, was measured for the sample taken without lignocaine (sample A) and the sample taken post-lignocaine application (sample B). The difference in Ct values of both the groups was checked for any statistical significance using paired t-test. Wilcoxon signed rank test was used on VAS scores to determine any significant decrease in discomfort. Results Forty patients were included in the study. Twenty-nine patients (72.5%) reported the procedure to be more comfortable post-lignocaine application. Median (IQR) discomfort on VAS decreased from 7 (1) to 5 (2) after lignocaine use, which was statistically significant (p 0.05), indicating a non-significant effect of lignocaine on SARS-CoV-2 concentration in the sample. Conclusion Topical lignocaine, while improving the comfort of the procedure of oropharyngeal sampling for patient did not alter the SARS-CoV-2 viral load that was detected in nasal and oropharyngeal samples taken together. Keywords Lignocaine · SARS coronavirus · RT-PCR
Introduction Real Time reverse-transcription polymerase chain reaction (RT-PCR) performed on adequately swabbed nasal and oropharyngeal tissue is considered the gold standard for diagnosing SARS-Coronavirus-2 (CoV-2) infection [1]. One of * Kapil Sikka [email protected] 1
Department of Otorhinolaryngology and Head‑ Neck Surgery, Room No 4057, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, Delhi 110029, India
2
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
3
Department of Pulmonary, Critical and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
4
Department of Oncoanesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
the major challenges while sampling is the gag and cough reflex that leads to droplet (5–10 𝜇m particles) expulsion and aerosol (
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