Evaluation Of Pharyngeal Lidocaine Anesthesia For Esophagogastroduodenoscopy: A Double Blind Randomized Control Trial.

Abstract

OBJECTIVES\nThe aim of this study was to assess whether the use of topical pharyngeal anesthesia improves endoscopist- and patient-reported tolerance and satisfaction, the total dose of propofol used and the rate of adverse effects associated with this procedure.\n\n\nMETHODS\nThis double-blind randomized clinical trial was conducted in patients undergoing elective oesophagogastroduodenoscopy, who met the inclusion criteria. Patients were randomly assigned to receive 5 squirts of lidocaine 10% spray (50 mg, n=268) or placebo (n=271) 3 minutes before starting the procedure or sedation. The main outcome measures were patient- and endoscopist-reported tolerance, and additionally, satisfaction with the procedure, adverse events and supplementary propofol used.\n\n\nRESULTS\nIn the lidocaine group, it was twice (OR=2.136; 95% CI, 1.228-3.715) or three times (OR=3.311; 95% CI, 1.623-6.757) more likely that the endoscopist rated the procedure as well tolerated and easy to intubate than as well-tolerated but the patient difficult to intubate or as poorly tolerated, respectively. Further, in these patients, less propofol was used (80 vs 100 mg, p=0.001). Controls were more likely to cough during the intubation (OR=2.172; 95% CI, 1.378-3.423) and the procedure (OR=1.989; 95% CI, 1.325-2.984), as well as more likely to retch (OR=3.582; 95% CI, 1.667-7.7).\n\n\nCONCLUSIONS\nTopical lidocaine may improve the procedure as rated by the endoscopist, as well as reduce the requirement for propofol and rate of adverse events such as retching and coughing. No adverse events associated with lidocaine administration were observed.