Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society | 2021
Lidocaine before esophageal manometry and ambulatory pH monitoring: A randomized controlled trial.
Abstract
BACKGROUND\nLidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to this practice and we aimed to confirm these findings in a randomized trial.\n\n\nMETHODS\nWe conducted a double-blind, randomized trial of lidocaine nasal spray versus placebo (saline) before EM and PM. Patients referred to our center who met inclusion criteria were enrolled. Patients were asked to fill a questionnaire after their test and patient-reported adverse effects were compared.\n\n\nKEY RESULTS\nThree hundred and four patients were enrolled in our trial. Lidocaine and placebo groups were demographically similar. The primary outcome, pain during catheter insertion, occurred in 60/148 (40.5%) patients in the lidocaine group versus in 72/152 (47.4%) patients in the placebo group (OR: 0.76 [95% CI: 0.48-1.20]; p\xa0=\xa00.23). Patients receiving lidocaine were less likely to report nausea during test recording (OR: 0.48 [95% CI: 0.24-0.91]; p\xa0=\xa00.02) and reported slightly lower intensity of pain during both catheter insertion and test recording (4.68\xa0±\xa02.06 versus 5.41\xa0±\xa02.24 on 10; p\xa0=\xa00.048 and 3.71\xa0±\xa02.00 versus 4.93\xa0±\xa02.55 on 10; p\xa0=\xa00.03, respectively). Furthermore, patients receiving lidocaine were less likely to report their test as globally uncomfortable and painful (57% vs. 75%; p\xa0=\xa00.003 and 14% vs. 21%; p\xa0=\xa00.02, respectively). No events of systemic lidocaine toxicity occurred during the study period.\n\n\nCONCLUSIONS\nRoutine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion but may provide other modest benefits with limited toxicity.