Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial

Abstract

Objectives The 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. Methods This double‐blind randomized clinical trial was conducted in patients undergoing elective oesophagogastroduodenoscopy, who met the inclusion criteria. Patients were randomly assigned to receive five squirts of lidocaine 10% spray (50 mg, n = 268) or placebo (n = 271) 3 min 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. Results In the lidocaine group, it was twice (odds ratio [OR] 2.136, 95% confidence interval [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). Conclusions Topical 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. ClinicalTrials registration no. NCT02733471.

Reply to “Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial” by Martín‐Marcos et al.

“…We read with interest the recent article by Martín‐Marcos et al 1 . evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy.…”

Response to reply to “Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial” by Martín‐Marcos et al.

“…We read with interest the letter by He et al 1 regarding our study evaluating the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy. 2 The authors question the clinical significance of the findings with respect to two issues.…”