Researchers from the University of Tennessee Health Science Center found moderate evidence supporting the use of intravenous (IV) lidocaine to decrease the amount of propofol required for sedation during gastrointestinal (GI) endoscopy. These findings were published in Gastrointestinal Endoscopy.

The investigators searched publication databases through October 13, 2020, for studies of endoscopy, colonoscopy, or endoscopic retrograde cholangiopancreatography (ERCP) that included the administration of propofol with or without lidocaine.

They included 5 studies published between 2016 and 2020 in this analysis. Of the 318 patients (range, 40-90 per study), 158 received propofol and lidocaine and 160 received propofol and placebo during colonoscopy (n=3), endoscopic submucosal dissection (n=1), and ERCP (n=1).


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Patients receiving lidocaine received reduced propofol doses compared with patients receiving placebo (standardized mean difference [SMD] -0.76; 95% CI, -1.09 to -0.42; I2 =52%). Among patients undergoing colonoscopy, those individuals receiving lidocaine received a smaller dose of propofol (SMD -0.82; 95% CI, -1.4 to -0.23; I2 =75%).

Patients receiving a low (2 mg/kg/h) or high (4 mg/kg/h) lidocaine dose received smaller propofol doses (low: SMD -0.89; 95% CI, -1.31 to -0.48; I2 =48%; high: SMD -0.53; 95% CI, -1.00 to -0.07; I2 =32%).

The researchers observed no difference for procedural length (SMD 0.16; 95% CI, -0.26 to 0.57; I2 =70%) nor for procedural adverse events (risk ratio [RR] 0.6; 95% CI, 0.35-1.03; I2 =59%) on the basis of lidocaine use.

Involuntary patient movement decreased among patients who received lidocaine (RR 0.22; 95% CI, 0.08-0.61; I2 =0).

This study was limited by the substantial heterogeneity observed among the underlying studies in addition to the small number of studies and the fact that only colonoscopy studies could be combined for a subgroup analysis.

These data indicated that administration of IV lidocaine, at higher or lower doses, reduced the amount of propofol given to patients during GI endoscopy procedures without altering procedural time or risk for adverse effects.

Reference

Kamal F, Khan M A, Lee-Smith W, et al. Efficacy and safety of supplemental intravenous lidocaine for sedation in gastrointestinal endoscopic procedures: Systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. Published online January 21, 2021.  doi:10.1016/j.gie.2021.01.008