Lidocaine Reduces Propofol Need During Endoscopic Retrograde Cholangiopancreatography

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A team of investigators from China sought to assess the effect of sedation with intravenous lidocaine during endoscopic retrograde cholangiopancreatography (ERCP).

The administration of intravenous lidocaine was found to reduce the amount of propofol needed during endoscopic retrograde cholangiopancreatography (ERCP) procedures, according to results from a randomized, double-blinded study published in Gastrointestinal Endoscopy.

A total of 48 patients scheduled to undergo ERCP at Qilu Hospital at Shandong University in China were randomly assigned to either a lidocaine or propofol group. All patients were premedicated with intravenous midazolam 0.02 mg/kg and sufentanil 0.1 µg/kg. Sedation was induced in the entire cohort with a bolus of propofol, with continued perfusion of propofol for maintenance. Patients in the lidocaine group (n=24) received a bolus of lidocaine 1.5 mg/kg followed by a continuous infusion of 2 mg/kg/h. Patients in the propofol group (n=24) received a bolus of propofol adjusted for age and American Society of Anesthesiologists physical classification system status (0.25 mg/kg for those aged >75 years or ASA III [severe systemic disease], 0.50 mg/kg for those aged 40-74 years, or 0.75 mg/kg aged <40 years), followed by a continuous infusion of 2 to 4 mg/kg/h, depending on patient age and health status. Additional propofol was administered to patients in both groups during the procedure based on patient comfort.

The investigators reported that patients in the lidocaine group required propofol 33.8% less frequently than those in the propofol group (212.0 ± 118.2 mg vs 320.0 ± 189.6 mg; P =.023). Involuntary movements were observed less frequently in patients receiving lidocaine compared with those receiving propofol (12.5% vs 41.7%; P =.049). Following the procedure, patients in the lidocaine group reported experiencing less pain (0 vs 3; P =.005) and fatigue (2 vs 5; P <.001) as demonstrated by visual analog scale score compared with those in the propofol group.

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Compared with the group receiving propofol, patients in the lidocaine group experienced significantly reduced induction time (2.6 ± 0.5 vs 3.2 ± 1.0 minutes; P =.015), time to awaken (2.5 ± 1.5 vs 9.2 ± 7.8 minutes; P <.001), and time to full recovery (5.6 ± 2.7 vs 15.0 ± 9.3 minutes; P <.001).

The investigators report limitations of this study to include the use of midazolam and sufentanil as premedications, as these drugs have been demonstrated to reduce the need for propofol and may have altered the study findings. Furthermore, body mass index measurements of the study participants were relatively low, (23.64 ± 3.5 kg/m2 for the lidocaine group and 23.0 ± 3.95 kg/m2 for the propofol group), so outcomes may not be generalizable to a heavier patient population.

In light of the reduced need for propofol, reduction in involuntary body movements, and alleviation of pain and fatigue reported by patients following ERCP, the study authors conclude that “lidocaine could be considered as an effective and safe adjuvant drug for ERCP sedation.”

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Liu J, Liu X, Peng L, Ji R, Liu C, Li Y-Q. Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial [published online March 7, 2020] Gastrointest Endosc doi:10.1016/j.gie.2020.02.050