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Double Blinded Randomised Controlled Trial Comparing Lidocaine Viscous and Lidocaine Lozenges Prior to Upper Gastrointestinal Endoscopy


Affiliations
1 Department of General Surgery, SS Institute of Medical Sciences and Research, Davanagere, Karnataka, India
2 Department of Surgery, SS Institute of Medical Sciences and Research, Davanagere, Karnataka, India
     

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Background: Upper gastrointestinal endoscopy is a commonly performed procedure now days for various indications. Usually it can be done as an outpatient procedure without anaesthesia and sedation. Local pharyngeal anaesthesia is used in the form of gel, viscous and spray. Recently there is introduction of lidocaine lozenges for this purpose with many benefits.

Objective: Purpose of this study was to compare the safety, efficacy and patient comfort for the lidocaine viscous and lidocaine lozenges as a single agent local pharyngeal anaesthesia before upper gastrointestinal endoscopy.

Design: Double blinded randomised prospective study.

Patients: 100 consecutive patients undergoing upper gastrointestinal endoscopy.

Methods and Interventions: Randomisation of patients was done into lidocaine viscous group and lidocaine lozenges group before the procedure and the endoscopist and patients were interviewed separately after the procedure. Anxiety, Gag reflex, difficulty of procedure and tolerability of the procedure were graded by the patients and endoscopist.

Results: Patients in the lozenges group exhibited less discomfort, tolerated the procedure better than that in the viscous group. The endoscopist experienced lesser difficulty in performing the procedure. None of the 100 patients needed any form of anaesthesia and all completed the procedure.

Conclusions: Lidocaine lozenge is a better alternative for local pharyngeal anaesthesia before upper gastrointestinal endoscopy. It resulted in lesser discomfort and increased tolerability of the procedure, for the patient and lesser difficulty in performing the procedure, for the endoscopist.


Keywords

Lidocaine Lozenge, Upper Gastrointestinal Endoscopy, Lidocaine Viscous, Comparative Study
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  • Ayoub C, Skoury A, Abdul-baki H, Nasr V, Soweid A. Lidocaine lollipop as a single agent anaesthesia in upper GI endoscopy. Gastrointest Endosc. 2007; 66(4): 786-793.
  • Walker B, Smith MJ. Upper gastrointestinal endsocopy – a survey of patients’ impression. Postgraduate Medical Journal. 1978 Apr; 54: 253-256.
  • ASGE - Guidelines for conscious sedation and monitoring during gastrointestinal endsocopy. Gastrointest Endosc. 2003; 58(3): 317-322.
  • LaLuna L, Allen ML, DiMarino A. The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine and topical lidocaine spray to sedate the patients for upper endoscopy. Gastrointest Endosc. 2001; 53(3): 289-293.
  • Cohen LB, Delegge MH, Aisenberg J., et al. AGA institute review of endoscopic sedation. Gastroenterology. 2007; 133:675-701.
  • Murthy TVSP. Sedation guidelines for gastro intestinal endoscopy. MJAFI. 2009; 65:161-165.
  • Lichtenstein DR, Jagannath S, Baron TH, et al. for Standards of practice committee. Sedation and anaesthesia in GI endoscopy. Gastrointest Endosc. 2008; 68(5): 815-826.
  • Zaman A, Hapke R, Sahagun G, Katon RM. Unsedated Peroral Endoscopy With a Video Ultrathin Endoscope: Patient Acceptance, Tolerance, and Diagnostic Accuracy. AJG. 1998 Aug; 93(8): 1260-1263.
  • Mulcahy HE, Riches A, Kiely M, Farthing MJG, Fairclough PD. A Prospective Controlled Trial of an Ultrathin Versus a Conventional Endoscope in Unsedated Upper Gastrointestinal Endoscopy. Endoscopy 2001; 33(4): 311-316
  • Carey EJ, Sorbi D. Unsedated endoscopy. Gastrointest Endosc Clin N Am. 2004 Apr; 14(2): 369-83.
  • Amornyotin S, Srikureja W, Chalayonnavin W, Kongphlay S, Chatchawankitkul S. Topical viscous lidocaine solution versus lidocaine spray for pharyngeal anaesthesia in unsedated esophagogastroduodenoscopy. Endoscopy. 2009 Jul; 41(7): 581-586.
  • Hedenbro JL, Ekelund M, Jansson O, Lindblom A. A randomized, double-blind, placebo-controlled study to evaluate topical anaesthesia of the pharynx in upper gastrointestinal endoscopy. Endoscopy. 1992 Aug; 24(6): 585-587.
  • Evans LT, Saberi S, Kim, HM, Elta GH, Schoenfeld P. Pharyngeal anaesthesia during sedated EGDs: is ‘‘the spray’’ beneficial? A meta-analysis and systematic review. Gastrointest Endosc. 2006; 63: 761-766.
  • Shaoul R, Higaze H, Lavy A. Evaluation of topical pharyngeal anaesthesia by benzocaine lozenge for upper endoscopy. Aliment Pharmacol Ther. 2006; 24: 687–694
  • Chakib Ayoub, Assad Scoury, Heitham Abdul- Baki, et al, Lidocaine Lollipop as a single agent anaesthesia in upper GI Endoscopy, 2007:volume 66, number 4:786-93.
  • Clarke GA., Jacobson BC., Hammet RJ., et al, The indications, utilisation and safety of gastrointestinal endoscopy in an extremely elderly patient cohort. Endoscopy, 2001: 33:580-4
  • Van Kouwen MC, Drenth JP, Verhoewen HM, et al, Upper gastrointestinal endoscopy in patients aged 85 years and more, results of a feasibility study in a district general hospital. Arch Gerontol Geriatr 2003:37:45-50.
  • Mulcahy HE, Kelly P, Banks MR et al, Factors associated with tolerance to and discomfort with unsedated diagnostic gastroscopy, Scand J Gastroenterol 2001:36:1352-7.
  • Dean R, Dua K, Massey B, et al, A comparitive study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc, 1996:44:422-4.
  • Brussaard CC, Vandewoude MF, A prospective analysis of elective upper gastrointestinal endoscopy in the elderly. Gastrointest Endosc 1988:34:118-21.
  • Chillemi S, Milici M, De Francesco F, et al, Sedation in endoscopic diagnosis: rationale of the use of specific benzodiazepine antagonists(italian), G Chir 1996;17:349-52.
  • Kulling D, Rothenbuhler R, Inauen W, Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscop. Endoscopy 2003;35:679-82.
  • Ristikankare M, Julkunen R, Mattila M, et al, conscious sedation and cardio respiratory safety during colonoscopy. Gastrointest Endosc 2000;52:48-54.
  • Tang WL, Liu SJ, Jiang XW, Associated sedation propofol and midazolam in small dosage in gastroscopy(chinese). Hunan Yi Ke Da Xue Xue Bao 2001;26:463-5.
  • Van Dam J, Brugge WR, Endoscopy of the upper gastrointestinal tract. N Eng J Med1999;341:1738-48.
  • Clarke AC, Chiragakis L, Hillman LC, et al, Sedation for endoscopy: the safe use of propofol by general practitioner seditionists. Med J Aust 2002;176:158-161.
  • Davis DE, Jones MO, Kubik CM,Topical pharyngeal anaesthesia for upper gastrointestinal endoscopy in conscious sedated patients. Am J Gastroenterol 1999;94;18536.
  • Dhir V, Swaroop VS, Vazifdar KF, et al. Topical pharyngeal anaesthesia without intravenous sedation during upper gastrointestinal endoscopy. Indian J Gastroenterol 1997;16:10-1.
  • Ljubicic N, Supanc V, Roic G, et al. Efficacy and safety of propofol sedation during urgent upper gastrointestinal endoscopy,a prospective study. Coll Antropol 2003;27:189-195.
  • Mulcahy HE, Greaves RR, Ballinger A et al. A double blind randomised trial of low dose versus high dose topical anaesthesia in unsedated upper gastrointestinal endoscopy. Aliment Pharmacol Ther 1996;10:975-977.
  • Leitch DG, Wicks J, el Beshir OA, et al. Topical anaesthesia with 50 mg of lidocaine spray facilitates upper gastrointestinal endoscopy. Gastrointest Endosc 1993;39;384-7.
  • Pereira S, Hussaini SH, Hanson PJ, et al. Endoscopy: throat spray or sedation? J R Coll Physicians Lond 1994;28:411-414.
  • Soma Y, Saito H, Kishibe T, et al. Evaluation of topical pharyngeal anaesthesia for upper endoscopy including factors associated with patient tolerance. Gastrointest Endosc 2001;53: 14-18.

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  • Double Blinded Randomised Controlled Trial Comparing Lidocaine Viscous and Lidocaine Lozenges Prior to Upper Gastrointestinal Endoscopy

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Authors

Zameer Ulla Tumminakatte
Department of General Surgery, SS Institute of Medical Sciences and Research, Davanagere, Karnataka, India
P. Nagaraj
Department of Surgery, SS Institute of Medical Sciences and Research, Davanagere, Karnataka, India

Abstract


Background: Upper gastrointestinal endoscopy is a commonly performed procedure now days for various indications. Usually it can be done as an outpatient procedure without anaesthesia and sedation. Local pharyngeal anaesthesia is used in the form of gel, viscous and spray. Recently there is introduction of lidocaine lozenges for this purpose with many benefits.

Objective: Purpose of this study was to compare the safety, efficacy and patient comfort for the lidocaine viscous and lidocaine lozenges as a single agent local pharyngeal anaesthesia before upper gastrointestinal endoscopy.

Design: Double blinded randomised prospective study.

Patients: 100 consecutive patients undergoing upper gastrointestinal endoscopy.

Methods and Interventions: Randomisation of patients was done into lidocaine viscous group and lidocaine lozenges group before the procedure and the endoscopist and patients were interviewed separately after the procedure. Anxiety, Gag reflex, difficulty of procedure and tolerability of the procedure were graded by the patients and endoscopist.

Results: Patients in the lozenges group exhibited less discomfort, tolerated the procedure better than that in the viscous group. The endoscopist experienced lesser difficulty in performing the procedure. None of the 100 patients needed any form of anaesthesia and all completed the procedure.

Conclusions: Lidocaine lozenge is a better alternative for local pharyngeal anaesthesia before upper gastrointestinal endoscopy. It resulted in lesser discomfort and increased tolerability of the procedure, for the patient and lesser difficulty in performing the procedure, for the endoscopist.


Keywords


Lidocaine Lozenge, Upper Gastrointestinal Endoscopy, Lidocaine Viscous, Comparative Study

References