Effect of intravenous lidocaine on propofol consumption in elderly patients undergoing colonoscopy: a double-blinded, randomized, controlled trial

Abstract

Background Elderly patients undergoing colonoscopy with propofol as sedation are prone to respiratory or cardiovascular complications. Intravenous lidocaine has analgesic efficacy and reduces propofol consumption during surgery. Here, the effect of intravenous lidocaine on propofol consumption was evaluated in elderly patients undergoing colonoscopy. Methods Patients were randomly allocated to receive intravenous lidocaine (1.5 mg/kg bolus dose, followed by a 2 mg/kg/h continuous infusion during the procedure; Group L) or a placebo (saline; Group N). During the procedure, sedation was achieved by propofol. The following outcomes were recorded: total propofol consumption; time to loss of consciousness; number of airway modifications; time to the first airway intervention; incidence of sedation-related events; pain score after awakening; endoscopists’ and patients’ satisfaction scores; memory level of the procedure; and adverse events within 24 h postoperatively. Results Compared with Group N, propofol consumption was reduced by 13.2% in Group L (100.30 ± 25.29 mg vs. 115.58 ± 27.52 mg, respectively, p = 0.008). Kaplan–Meier curves showed that the median time to the loss of consciousness episode was shorter in Group L than in Group N (40 s vs. 55 s, respectively, log rank p < 0.0001). The number of airway modifications, time to the first airway intervention, incidence of sedation-related events, time to awakening, pain score after awakening, endoscopists’ and patients’ satisfaction scores, memory level of the procedure and adverse events within 24 h postoperatively did not differ between the two groups (p > 0.05). Conclusions Intravenous lidocaine can reduce propofol consumption in elderly patients undergoing colonoscopy, with quicker time to loss of consciousness. Trial registration The clinical trial was registered at (12/01/2021, ChiCTR2100042001).

Effect of intravenous lidocaine on the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy: a prospective, randomized, double-blinded, controlled study

“…Our study found that the ED50 of propofol induction dose in elderly patients undergoing painless gastroscopy was 0.670 mg/kg when combined with intravenous lidocaine, a significant 40% reduction from the ED50 of 1.118 mg/kg without lidocaine. The finding regarding the propofol-sparing effect of intravenous lidocaine was consistent with previous studies (Chen et al 2020 ; Hu et al 2022 ; Li et al 2022 ). The mechanism underlying this propofol-sparing effect may be attributed to the anti-nociceptive stimulus of lidocaine in this patient group(Hans et al 2010 ).…”

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

“…Propofol has the advantages of rapid onset and quick recovery and is often used in gastroscopy [6]. However, propofol quickly causes adverse side effects, including hypotension and hypoxemia [7][8][9], and propofol injection pain also cannot be ignored [10]. Alfentanil is a short-acting opioid analgesic with high analgesic intensity and similar complication risks to other opioids.…”

Comparison of Fentanyl, Ketamine, and Lidocaine Combined with Propofol Anesthesia in Patients with Crohn Disease Undergoing Colonoscopy

“…The literature also indicates that LID can reduce propofol needs during colonoscopy anesthesia, although the evidence is less uniform than that for KET, showing greater variance [27][28][29][30]. For instance, Forster et al reported a 50% reduction in total propofol use with LID infusion, whereas Li et al observed only a 13.2% decrease [27,28]. Such variation could be attributed to the LID dosage, usage of additional drugs, and patient demographics.…”