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Efficacy and safety of supplemental intravenous lidocaine for sedation in gastrointestinal endoscopic procedures: systematic review and meta-analysis of randomized controlled trials

Published:January 20, 2021DOI:https://doi.org/10.1016/j.gie.2021.01.008

      Background and aims

      Some studies have shown that intravenous (IV) lidocaine reduces the dose requirement of propofol in GI endoscopic procedures. We conducted this study to evaluate the efficacy and safety of the combination of IV lidocaine and propofol compared with propofol alone in GI endoscopic procedures.

      Methods

      We reviewed several databases from inception to October 13, 2020, to identify randomized controlled trials (RCTs) that compared the role of IV propofol and lidocaine with IV propofol plus placebo for sedation in endoscopic procedures. Our outcomes of interest were the differences in total dose of propofol administered, procedure time, and intraoperative adverse events. For categorical variables, we calculated pooled risk ratios with 95% confidence intervals (CI); for continuous variables, we calculated standardized mean difference (SMD) with 95% CI. Data were analyzed using a random effect model. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework to ascertain the quality of evidence.

      Results

      We included 5 randomized controlled trials with 318 patients. We found that the total dose of propofol administered was significantly lower in the lidocaine group than the control group (SMD, −0.76; 95% CI, −1.09 to −0.42). We found no significant difference in procedure time (SMD, 0.16; 95% CI, −0.26 to 0.57) or adverse events (risk ratio, 0.60; 95% CI, 0.35-1.03) between the groups. There was moderate to substantial heterogeneity in the data. Quality of evidence based on the GRADE framework ranged from low to moderate.

      Conclusions

      Moderate quality of evidence suggests that IV lidocaine decreases the dose of propofol administered for GI endoscopic procedures.

      Abbreviations:

      CI (confidence interval), GRADE (Grading of Recommendations Assessment, Development and Evaluation), IV (intravenous), PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis), RCT (randomized controlled trial), RR (risk ratio), SMD (standardized mean difference)
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      References

        • McQuaid K.R.
        • Laine L.
        A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures.
        Gastrointest Endosc. 2008; 67: 910-923
        • Wadhwa V.
        • Issa D.
        • Garg S.
        • et al.
        Similar risk of cardiopulmonary adverse events between propofol and traditional anesthesia for gastrointestinal endoscopy: a systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2017; 15: 194-206
        • American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association Institute, American Society for Gastrointestinal Endoscopy, et al
        Multisociety sedation curriculum for gastrointestinal endoscopy.
        Gastroenterology. 2012; 143: e18-e41
        • Sethi S.
        • Wadhwa V.
        • Thaker A.
        • et al.
        Propofol versus traditional sedative agents for advanced endoscopic procedures: a meta-analysis.
        Dig Endosc. 2014; 26: 515-524
        • Goudra B.G.
        • Singh P.M.
        SEDASYS, sedation, and the unknown.
        J Clin Anesth. 2014; 26: 334-336
        • Eastwood P.R.
        • Platt P.R.
        • Shepherd K.
        • et al.
        Collapsibility of the upper airway at different concentrations of propofol anesthesia.
        Anesthesiology. 2005; 103: 470-477
        • Forster C.
        • Vanhaudenhuyse A.
        • Gast P.
        • et al.
        Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study.
        Br J Anaesth. 2018; 121: 1059-1064
        • Dunn L.K.
        • Durieux M.E.
        Perioperative use of intravenous lidocaine.
        Anesthesiology. 2017; 126: 729-737
        • Ness T.J.
        Intravenous lidocaine inhibits visceral nociceptive reflexes and spinal neurons in the rat.
        Anesthesiology. 2000; 92: 1685-1691
        • Kwon J.S.
        • Kim E.S.
        • Cho K.B.
        • et al.
        Incidence of propofol injection pain and effect of lidocaine pretreatment during upper gastrointestinal endoscopy.
        Dig Dis Sci. 2012; 57: 1291-1297
        • Wang J.
        • Duan J.
        • Xie C.
        • et al.
        Comparison between intravenous nalbuphine and lidocaine in reducing propofol-induced injection pain during gastroscopy: a randomized controlled trial.
        Pain Ther. 2020; 9: 563-571
        • Liu J.
        • Liu X.
        • Peng L.P.
        • et al.
        Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial.
        Gastrointest Endosc. 2020; 92: 293-300
        • Chen M.
        • Lu Y.
        • Liu H.
        • et al.
        The propofol-sparing effect of intravenous lidocaine in elderly patients undergoing colonoscopy: a randomized, double-blinded, controlled study.
        BMC Anesthesiol. 2020; 20: 132
        • Li X.
        • Lv X.
        • Jiang Z.
        • et al.
        Application of intravenous lidocaine in obese patients undergoing painless colonoscopy: a prospective, randomized, double-blind, controlled study.
        Drug Des Devel Ther. 2020; 14: 3509-3518
        • Kim J.E.
        • Choi J.B.
        • Koo B.N.
        • et al.
        Efficacy of intravenous lidocaine during endoscopic submucosal dissection for gastric neoplasm: a randomized, double-blind, controlled study.
        Medicine (Baltimore). 2016; 95: e3593
        • El Beheiry H.
        • Mak P.
        Effects of aging and propofol on the cardiovascular component of the autonomic nervous system.
        J Clin Anesth. 2013; 25: 637-643
        • Hans G.A.
        • Lauwick S.M.
        • Kaba A.
        • et al.
        Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation.
        Br J Anaesth. 2010; 105: 471-479
        • Altermatt F.R.
        • Bugedo D.A.
        • Delfino A.E.
        • et al.
        Evaluation of the effect of intravenous lidocaine on propofol requirements during total intravenous anaesthesia as measured by bispectral index.
        Br J Anaesth. 2012; 108: 979-983
        • Faraoni D.
        • Schaefer S.T.
        Randomized controlled trials vs. observational studies: why not just live together?.
        BMC Anesthesiol. 2016; 16: 102
        • Beaussier M.
        • Delbos A.
        • Maurice-Szamburski A.
        • et al.
        Perioperative use of intravenous lidocaine.
        Drugs. 2018; 78: 1229-1246
        • De Martin S.
        • Orlando R.
        • Bertoli M.
        • et al.
        Differential effect of chronic renal failure on the pharmacokinetics of lidocaine in patients receiving and not receiving hemodialysis.
        Clin Pharmacol Ther. 2006; 80: 597-606
        • Abernethy D.R.
        • Greenblatt D.J.
        Lidocaine disposition in obesity.
        Am J Cardiol. 1984; 53: 1183-1186
        • Abernethy D.R.
        • Greenblatt D.J.
        Impairment of lidocaine clearance in elderly male subjects.
        J Cardiovasc Pharmacol. 1983; 5: 1093-1096
        • Bajracharya J.L.
        • Subedi A.
        • Pokharel K.
        • et al.
        The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial.
        BMC Anesthesiol. 2019; 19: 198
        • Dogan S.D.
        • Ustun F.E.
        • Sener E.B.
        • et al.
        Effects of lidocaine and esmolol infusions on hemodynamic changes, analgesic requirement, and recovery in laparoscopic cholecystectomy operations.
        Braz J Anesthesiol. 2016; 66: 145-150