Topical pharyngeal anesthesia provides no additional benefit to propofol sedation for esophagogastroduodenoscopy: a randomized controlled double-blinded clinical trial

Abstract

Propofol sedation has been applied during esophagogastroduodenoscopy procedures, but whether topical pharyngeal anesthesia should be administered at the same time has rarely been reported. Our study examined the role of topical pharyngeal anesthesia in sedated endoscopies in a randomized controlled double-blinded clinical trial. A total of 626 patients who underwent sedated esophagogastroduodenoscopy were randomized into the experimental group (n = 313) or the control group (n = 313). The discomfort score, immediately and one day after the procedure, was not statistically significant [7.2 (5–9) vs. 7.5 (6–9), P = 0.210; 2.3 (0–3) vs. 2.6 (0–4), P = 0.095, respectively]. Two patients in the experimental group and three patients in the control group needed oral medication for pharyngeal discomfort (P = 0.354). The satisfaction score was 9.2 (8–10) in the experimental group and 8.9 (7–10) in the control group (P = 0.778). Lidocaine topical pharyngeal anesthesia in propofol-sedated esophagogastroduodenoscopy did not further reduce the pharyngeal discomfort or improve the satisfaction. This clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT03070379).

Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta‐analysis

“…A previous systematic review reported that pharyngeal local anesthesia improved patient tolerance during UGI endoscopy under traditional sedation, such as with midazolam or meperidine 6 . However, previous RCTs showed that local anesthesia did not affect the total propofol dose, or patient responsiveness 32–34 . These differences indicate that depth of sedation with sufficient amnesia may be important.…”

“…6 However, previous RCTs showed that local anesthesia did not affect the total propofol dose, or patient responsiveness. [32][33][34] These differences indicate that depth of sedation with sufficient amnesia may be important. Minimal sedation usually includes intravenous benzodiazepines, and conscious sedation to deep sedation includes high doses of benzodiazepines, or intravenous propofol.…”

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

“…S8). 29,31,32 Moreover, no significant difference between i.v. and topical subgroups was found on subgroup analysis (P¼0.22).…”

“…Six studies involving a total of 948 patients (lidocaine group, n¼473 vs placebo group, n¼475) were available for analysis. 21,25,28,31,32,34 The forest plot demonstrated a lower pain or discomfort score among patients receiving lidocaine than that in those being given placebos (SMD¼À0.47, 95% CI: À0.8 to À0.14, P¼0.005; I 2 ¼73%) (Supplementary Fig. S6).…”

“…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. lidocaine on clinical outcomes, 21,25,26,28e31 whereas five trials investigated the benefit of topical lidocaine.…”