Topical anesthesia with ropivacaine has been reported to attenuate extubation response in hypertensive surgical patients and by trans-cricothyroid membrane injection. But in genrenal population and with other mode of administration, the effect of topical ropivacaine anesthesia was not clear. The purpose of this study was to investigate whether topical ropivacaine anesthesia can increase the tolerance to the endotracheal tube to facilitate early and rapid recovery of surgical patients (enhanced recovery after surgery, ERAS) post-thyroidectomy.

The airway reflex such as cough is common accompanied with severe fluctuations of hemodynamics during emergence. This prospective double-blind randomized controlled trial tested the hypothesis that topical ropivacaine may reduce extubation response and postoperative sore throat.

Primary outcomes 

Fifty-four patients undergoing thyroidectomy were randomly assigned to two groups. The patients in Group R were received 0.75% ropivacaine, which was sprayed on the tracheal mucosa, epiglottis, tongue base, and glottis to achieve uniform surface anesthesia. As control, patients in Group C have received the same volume saline. The primiary outcome was the incidence and grade of cough during peri-extubation.

Sore throat visual activity 

The incidence (34.62% vs. 76.92%, P = 0.002) of cough during extubation were lower in Group R compared to Group C. Meanwhile, the sore throat visual acuity score at 12 h after surgery was lower in Group R than that in Group C (2.00 vs. 3.50, P = 0.040).

Topical anesthesia with 0.75% ropivacaine before intubation can significantly reduce the incidence of cough during peri-extubation. Meanwhile, it reduced hemodynamic fluctuations and postoperative throat pain without influence patients recovery.