NO RISK OF ASPIRATION AFTER ADMINISTRATION OF NEW BUPIVACAINE LOZENGE TO HEALTHY SUBJECTS AND HEAD AND NECK CANCER PATIENTS WITH ORAL MUCOSITIS - A PILOT STUDY

Background: Local anaesthetics are widely used as anaesthesia and pain management in the oral cavity, but there is currently no sufficient pain management for severe oral pain. Therefore a new bupivacaine lozenge as local oro-mucosal and pharynx anaesthesia could be interesting. However, it has previously been assumed that pharyngeal anaesthesia induces a risk of dysphagia and aspiration, including that it affects the self-regulating swallowing reflex.

The aim of the study was to investigate the risk of aspiration after anaesthetizing the oral cavity and pharynx with a bupivacaine lozenge as topical anaesthesia in healthy subjects and head and neck cancer patients with oral mucositis.

Methods: Ten healthy subjects and ten head and neck cancer patients with oral mucositis were administrated a 25 mg bupivacaine lozenge as single dose. The patients were examined for aspiration by swallowing 20 ml liquid contrast agent during fluoroscopy before administration of the lozenge and after the lozenge was completely dissolved, whereas the healthy subjects were only examined after. Videos were analysed for aspiration by an experienced radiologist.

Results: None of the healthy subjects or the patients showed signs of aspiration before or after administration of the bupivacaine lozenge. One head and neck cancer patient coughed when swallowing the contrast agent after administration of the lozenge but showed no sign of aspiration.

Conclusion: The results indicate that the bupivacaine lozenge is safe to use before eating and drinking for both healthy subjects and head and neck patients with oral mucositis after single-dose administration.