Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study

Abstract

Background: Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery. Methods: Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg À1 then 4 mg kg À1 h À1) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue. Results: Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P¼0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P¼0.03) were significantly lower in the lidocaine group. Conclusions: Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine. Clinical trial registration: NCT 02784860.

<p>Application of Intravenous Lidocaine in Obese Patients Undergoing Painless Colonoscopy: A Prospective, Randomized, Double-Blind, Controlled Study</p>

“…These results are in agreement with those obtained by Forster and colleagues. 15 We found that, during colonoscopy, the intraoperative HR and SBP in group L were lower than those in group N. This difference can be explained (at least in part) by the analgesic effect provided by lidocaine. Bradycardia and hypotension are common adverse reactions of propofol.…”

“…However, other studies have shown that IV lidocaine in non-obese patients could result in a remarked reduction of propofol during colonoscopy. 15,50 There are no lidocaine-related adverse reactions in patients undergoing bariatric surgery. 49 However, we will further explore the efficacy of intravenous lidocaine in non-obese patients.…”

“…14 Forster and colleagues also showed that IV lidocaine could result in a 50% reduction in propofol requirements when combined with ketamine during procedural sedation and analgesia (PSA) for colonoscopy. 15 However, whether IV lidocaine can reduce the number of oxygen-desaturation episodes in obese patients undergoing colonoscopy has not been investigated. We hypothesized that IV lidocaine could lower the prevalence of respiratory depression during colonoscopy in obese patients.…”

Effects of Intravenous Lidocaine on Alfentanil Consumption During Procedural Sedation for Colonoscopy in Patients With Inflammatory Bowel Disease: a Randomized Controlled Trial

“…Lidocaine reduced propofol requirements, and improved postcolonoscopy pain and fatigue. (12) The effect of lidocaine on opioid consumption during PSA has not…”

“…(10,11) One study showed that lidocaine reduces the use of propofol during colonoscopy, though did not evaluate opioid administration. (12) Based on these studies, lidocaine could be a promising additional analgesic in IBD patients to minimise side effects on PSA.…”