New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

Abstract

ObjectiveTo evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort mostly because of the gag reflex.ParticipantsThe single-blinded, randomized, controlled study involved 110 adult patients undergoing diagnostic UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark.MethodsThe patients were randomized to receive either 100 mg lidocaine as a lozenge or 5 mL lidocaine viscous oral solution 2%. Intravenous midazolam was administered if needed. The effect of a lidocaine lozenge in reducing patient discomfort, including the gag reflex, during UGE compared with a lidocaine oral solution was assessed.ResultsQuestionnaires from the patients showed that the gag reflex was acceptable for 64% in the lozenge group compared with 33% in the oral solution group (P = 0.0072). UGE was evaluated as acceptable by 69% in the lozenge group compared with 39% in the oral solution group (P = 0.0092). The taste was evaluated as good by 78% in the lozenge group (P < 0.0001), and 82% found the lozenge to have good texture (P < 0.0001).ConclusionThe lozenge reduced the gag reflex, diminished patients’ discomfort during UGE, and was evaluated as having a good taste and texture. The lozenge improved patients’ acceptance of UGE.

Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial

“…The lollipop had a good taste and was well tolerated by the majority of patients. 8 A newer study by our research group Mogensen et al 12 evaluated the effect and acceptance of a lidocaine lozenge (100 mg of lidocaine) compared with a lidocaine viscous oral solution (100 mg of lidocaine). The lozenge significantly improved the patient’s acceptance of the discomfort, the gag reflex, and the UGE.…”

“…Furthermore, the lidocaine lozenge as topical pharyngeal anesthesia seemed to be both effective and palatable. 12 , 18 …”

“…As some of the studies included conscious sedated patients, this can introduce bias due to impaired judgment following sedation. 12 To avoid this bias, the present study solely included unsedated patients. Despite the use of conscious sedation, similar results to our study were achieved by Ayoub et al 8 and Mogensen et al, 12 showing a superior effect for the lidocaine lollipop and the lidocaine lozenge.…”

“… 12 To avoid this bias, the present study solely included unsedated patients. Despite the use of conscious sedation, similar results to our study were achieved by Ayoub et al 8 and Mogensen et al, 12 showing a superior effect for the lidocaine lollipop and the lidocaine lozenge. In our study the bupivacaine lozenge decreased the discomfort the patients experienced during an UGE compared with the lidocaine spray.…”

“… 8 Several studies have found the lidocaine pharyngeal anesthesia to be beneficial. 9 – 11 In a study by our research group Mogensen et al, 12 a lidocaine lozenge was found to be superior to lidocaine solution. In order to ease administration, improve the lozenge, and increase the time of anesthesia during UGE, a smaller lozenge with taste masking was formulated and bupivacaine was chosen as the active pharmaceutical ingredient (API).…”