Ultrasound-guided modified superior laryngeal nerve block for awake tracheal intubation in patients with difficult airways

To evaluate the efficacy of an ultrasound-guided modified superior laryngeal nerve block for awake tracheal intubation in patients with anticipated difficult airways. This study included 60 patients with difficult airways who were scheduled for orthopedic surgery under general anesthesia. The study was conducted at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2024 to December 2025. Patients were grouped according to routine clinical practice. The experimental group received an ultrasound-guided modified superior laryngeal nerve block ( n = 30), whereas the control group received topical anesthesia via fiberoptic bronchoscope-guided supraglottic spraying ( n = 30). Intubation time and success rate were recorded. Cough response was graded, patient satisfaction was assessed, and peri-procedural complications were documented. Baseline characteristics were comparable between the two groups ( p > 0.05). Intubation time was shorter in the experimental group than in the control group (1.73 ± 0.44 vs. 2.70 ± 0.46 min; p < 0.001). The success rate was also higher in the experimental group (100% vs. 83%; p = 0.020). Cough responses were attenuated, with 90% of patients in the experimental group showing Grade I responses, whereas Grade III-IV responses were more frequent in the control group (37%) ( p = 0.026). Patient comfort was better in the experimental group, with 90% versus 40% rated as “good” ( p < 0.001), and poor comfort occurred only in the control group (37%). The incidences of tachycardia and hypertension were lower in the experimental group, although the differences were not statistically significant ( p > 0.05). No laryngospasm, bleeding, or nerve injury was observed in either group. Ultrasound-guided modified superior laryngeal nerve block was associated with shorter intubation time and attenuated cough response during awake tracheal intubation in patients with difficult airways. Higher procedural success and patient satisfaction were achieved without an increase in complications. This approach appears to be safe and feasible in the described clinical setting.