Pre‐procedure intravenous lidocaine administration on propofol consumption for endoscopic retrograde cholangiopancreatography: A prospective, randomized, double‐blind study

Abstract

Background and Aim The endoscopic retrograde cholangiopancreatography (ERCP) procedure is generally performed in patients with high comorbidity. We aimed to reduce the consumption of propofol by adding lidocaine before ERCP. Methods Eighty ERCP patients with ASA I–III, aged between 45–75 years, were randomly divided into two groups. Lidocaine group (group L, n = 40), received 1‐mg midazolam, 1.5 mg/kg lidocaine, and 1 mg/kg propofol intravenously. The control group (group C, n = 40) received 1‐mg midazolam, saline in the same volume as the lidocaine group, and 1 mg/kg propofol intravenously. Propofol was administered with intermittent bolus doses. Propofol consumption, oropharyngeal reflex, recovery time, endoscopist satisfaction, ketamine need, and side‐effects were recorded. Results Propofol consumption during the procedure was statistically lower in group L than in the control group (157.25 ± 39.16 mg vs 228.75 ± 64.62 mg respectively, P < 0.001). Additionally, recovery time was statistically faster in group L compared with the control group (7.78 ± 3.95 min vs 11.92 ± 3.24 min respectively, P < 0.001). The oropharyngeal reflex was less in group L than control group (6/40 vs 15/40 respectively, P = 0.042). There was no significant difference between the two groups regarding visual analogue scale scores and endoscopist satisfaction (P > 0.05). Conclusions We recommend the use of intravenous lidocaine before the ERCP procedure as it reduces propofol consumption, recovery times, and oropharyngeal reflex.

Use of intravenous lidocaine for dose reduction of propofol in paediatric colonoscopy patients: a randomised placebo-controlled study

“…The effects of propofol on hemodynamics and respiratory depression were dose-dependent, and the reduction of propofol dose could lower the occurrence of cardiopulmonary adverse events [ 24 ]. In addition, relevant studies showed that reduce the dosage of propofol could shorten the recovery time, which was consistent with the results we obtained [ 25 ].…”

Impact of intravenous and topical lidocaine on clinical outcomes in patients receiving propofol for gastrointestinal endoscopic procedures: a meta-analysis of randomised controlled trials

“…ASA 3). 22,25,27,29,31,34 However, two trials did not specify the status of patients. 28,32 Seven trials assessed the impact of i.v.…”

“…22,27,32e34 Focusing on the administration strategy of i.v. lidocaine, two studies 25,30 used an i.v. bolus of 1.5 mg kg À1 without subsequent infusion, while the same bolus dosage was adopted followed by a continuous lidocaine infusion at a dose of 4 mg kg À1 h À1 in two trials 21,26 and 2 mg kg À1 h À1 in three trials.…”

“…Eight studies involving a total of 779 patients (lidocaine group, n¼385 vs placebo group, n¼394) reported the incidence of oxygen desaturation for analysis. 21,22,25,26,28,30,31,33 The definitions of oxygen desaturation of the included studies are demonstrated in Supplementary Table S4. The pooled RR of oxygen desaturation was 0.72 (95% CI: 0.41e1.24, P¼0.39, I 2 ¼5%) (Fig.…”

“…lidocaine was associated with a significant reduction in recovery time (SMD¼À0.83, 95% CI: À1.45 to À0.21, P¼0.009), there was no difference in recovery time between the topical lidocaine and placebo groups (SMD¼0.19, 95% CI: À0.21 to 0.60, P¼0.35). Omitting two of the trials 25,31 significantly impacted the outcomes on sensitivity analysis.…”