Lidocaine before esophageal manometry and ambulatory pH monitoring: A randomized controlled trial

Abstract

Background: Lidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to this practice and we aimed to confirm these findings in a randomized trial. Methods:We conducted a double-blind, randomized trial of lidocaine nasal spray versus placebo (saline) before EM and PM. Patients referred to our center who met inclusion criteria were enrolled. Patients were asked to fill a questionnaire after their test and patient-reported adverse effects were compared.Key Results: Three hundred and four patients were enrolled in our trial. Lidocaine and placebo groups were demographically similar. The primary outcome, pain during catheter insertion, occurred in 60/148 (40.5%) patients in the lidocaine group versus in 72/152 (47.4%) patients in the placebo group (OR: 0.76 [95% CI: 0.48-1.20]; p = 0.23).Patients receiving lidocaine were less likely to report nausea during test recording (OR: 0.48 [95% CI: 0.24-0.91]; p = 0.02) and reported slightly lower intensity of pain during both catheter insertion and test recording (4.68 ± 2.06 versus 5.41 ± 2.24 on 10; p = 0.048 and 3.71 ± 2.00 versus 4.93 ± 2.55 on 10; p = 0.03, respectively). Furthermore, patients receiving lidocaine were less likely to report their test as globally uncomfortable and painful (57% vs. 75%; p = 0.003 and 14% vs. 21%; p = 0.02, respectively). No events of systemic lidocaine toxicity occurred during the study period.Conclusions: Routine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion but may provide other modest benefits with limited toxicity.

Virtual Reality for Pain Management During High‐Resolution Manometry: A Randomized Clinical Trial

“…The effect of lidocaine on pain management has been studied before, including in HRM, with mixed results. 25 A Cochrane review of eight randomized controlled trials concluded that topical anesthetic did not reduce pain or discomfort. 26 Researchers have suggested further investigation of topical anesthetic during transnasal manometry is indicated, as transnasal manometry is particularly painful.…”

“…Indeed, transnasal procedures are commonly performed in the awake patient and are known to be associated with pain. The effect of lidocaine on pain management has been studied before, including in HRM, with mixed results 25 . A Cochrane review of eight randomized controlled trials concluded that topical anesthetic did not reduce pain or discomfort 26 .…”

When to p and when not to p

“…Wahba and collaborators 7 reported that “Routine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion.” They observed an OR = 0.758 (95% CI 0.467–1.228), which can be interpreted as a 24% reduction in the odds of occurrence of pain during catheter insertion, which patients may consider as an important result. For illustration purposes, if the exact same OR result had been obtained in a study three times as large ( n = 900 as opposed to n = 300 patients), one would have “achieved statistical significance” (see tables below) and would have probably stated “Routine use of lidocaine before esophageal function tests does reduce pain during catheter insertion.”…”

“…Wahba and collaborators 7 reported that "Routine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion." They observed an OR = 0.758 (95% CI 0.467-1.228), which can be interpreted as a 24% reduction in the odds of occurrence of pain during catheter insertion, which patients may consider as an important result.…”

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

“…Most patients tolerate the examination (>95%) [ 29 ]. The catheter insertion may be associated with significant pain, and the pH probe may cause belching and coughing during the early part of the monitored period, especially in patients with esophageal or laryngopharyngeal mucosa hypersensitivity [ 29 , 30 ]. The pharyngeal probe placement difficulties and movements are both points that were frequently considered as weaknesses of the technique, leading to probe movement and false-positive diagnostic [ 29 , 31 ].…”