Introduction: The preferred management strategy for difficult airways is awake fiberoptic bronchoscopy guided intubation, which requires effective airway anaesthesia to ensure patient comfort and acceptance. This prospective case control study was conducted to compare lignocaine nebulisation and airway nerve block for airway anaesthesia prior awake intubation. Aim: To compare lignocaine nebulisation and airway nerve block for awake fiberoptic bronchoscopy guided nasotracheal intubation. Methodology: Twenty adult patients scheduled for surgical procedures under general anaesthesia were studied under two groups depending upon the premedication recieved. Group N received jet nebulisation (10ml of 4% lignocaine) and Group B received bilateral superior laryngeal and transtracheal recurrent laryngeal nerve block(each with 2ml of 2% lignocaine) followed by fiberoptic bronchoscopy–guided nasotracheal intubation. All patients received procedural sedation with dexmedetomidine. The intubation time, intubating conditions, vocal cord position, cough severity and degree of patient satisfaction were recorded. Student’s t test used to analyse quantitative data and Fisher’s test to qualitative data. P values <0.05 were considered statistically significant. Result: The time taken for intubation was significantly shorter in Group B as compared to Group N (P = 0.029). The intubating conditions and degree of patient comfort were better in Group B compared to Group N. Although all patients were successfully intubated, patient satisfaction was higher in Group B.Conclusion: Airway nerve blocks are preferable to lignocaine nebulisation as they provide superior quality airway anaesthesia. However, nebulisation may be a suitable alternative when nerve block is not feasible.