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

Abstract

Background Propofol, a widely used sedative in endoscopic procedures, sometimes causes cardiopulmonary complications. Intravenous lidocaine can diminish visceral pain and decrease the dose of propofol. The purpose of this study was to assess the efficacy and safety of intravenous lidocaine in reducing propofol dosage during paediatric colonoscopy. Methods Forty children who underwent colonoscopy were divided into two groups. Lidocaine hydrochloride (1.5 mg/kg induction and 2 mg/kg/h maintenance) was given intravenously to the lidocaine group, and the same amount of saline was given to the control group after they received lidocaine induction. Propofol initial plasma concentration of 5 μg/mL was targeted, and the procedure was performed after the bispectral index value reached 55. The primary outcome was propofol requirement. Results The propofol requirement in the lidocaine group was decreased by 35.5% (128.6 ± 30.4 mg vs. 199.4 ± 57.6 mg; p < 0.001; 95%CI: − 100.60, − 41.02). The incidence of involuntary body movements was significantly lower in the lidocaine group (p = 0.028; OR = 0.17; 95%CI: 0.03, 0.92). The awakening time (p < 0.001; 95%CI: − 7.67, − 5.13) and recovery times (p < 0.001; 95%CI: − 7.45, − 4.35) were significantly lower in the lidocaine group. Pain was significantly less at 30 min and 60 min after the procedure in the lidocaine group (0 [0–4] vs. 3 [0–5], p < 0. 001; 0 [0–2] vs. 1 [0–3], p = 0.001). There was no difference in the incidence of bradycardia, hypotension, or hypoxia between the two groups. Conclusions For colonoscopy procedures in paediatric patients, intravenous lidocaine reduces the amount of propofol needed, provides better sedation and postprocedural pain management, as well as a reduction in recovery time. Trial registration The trial was registered on November 6, 2020 at China Clinical Trials Registration Center (www.chictr.org.cn) ref.: ChiCTR 2,000,039,706.

The Effect of Preoperative Combined with Intravenous Lidocaine and Ketamine vs. Intravenous Ketamine on Pediatric Patients Undergoing Upper Gastrointestinal Endoscopy

“…The propofol requirement and recovery time were significantly lower in the intervention group than in the control group. There was no significant difference between the 2 groups regarding complications such as hypotension, bradycardia, and hypoxia ( 29 ). Conflicting results of these studies and our study can be attributed to intraoperative lidocaine infusion in these studies, different anesthesia methods, and the younger age of our participants.…”

“…Studies have indicated favorable effects with fewer adverse effects in favor of combination therapy for sedation during pediatric endoscopy. Ketamine is often used for sedation during this procedure ( 27 ), and IV lidocaine is still being studied as an adjuvant anesthetic for sedation and analgesia ( 28 , 29 ).…”

Lidocaine, old drug - new possibilities. Treatment of postoperative pain and reduction of postoperative complications with intravenous administration

“…Badania wykazały znaczną redukcję tego powikłania, kiedy indukcja znieczulenia poprzedzona była podawaniem dożylnej lidokainy [42,43]. Wykazano również możliwość redukcji dawek propofolu podczas wykonywania zabiegów endoskopowych [44,45].…”

Effects of adding intravenous lidocaine to propofol-based sedation for colonoscopy: a systematic review and meta-analysis

“…In terms of awakening time, only the subgroup<18 years benefited from adding lidocaine, while the other two subgroups showed a non-significant difference between propofol/lidocaine and propofol/placebo groups. 1 2 3 4 5 6 7 8…”