New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

Abstract

Stine Mogensen,1 Charlotte Treldal,1 Erik Feldager,2 Sylvia Pulis,1 Jette Jacobsen,3 Ove Andersen,1 Mette Rasmussen,41Clinical Research Centre, Hvidovre University Hospital, Copenhagen, Denmark; 2Department of Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark; 3Department of Pharmaceutics and Analytical Chemistry, Faculty of Pharmaceutical Sciences, University of Copenhagen, Denmark; 4Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical Sciences, University of Copenhagen, DenmarkObjective: To evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort mostly because of the gag reflex.Participants: The single-blinded, randomized, controlled study involved 110 adult patients undergoing diagnostic UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark.Methods: The patients were randomized to receive either 100 mg lidocaine as a lozenge or 5 mL lidocaine viscous oral solution 2%. Intravenous midazolam was administered if needed. The effect of a lidocaine lozenge in reducing patient discomfort, including the gag reflex, during UGE compared with a lidocaine oral solution was assessed.Results: Questionnaires from the patients showed that the gag reflex was acceptable for 64% in the lozenge group compared with 33% in the oral solution group (P = 0.0072). UGE was evaluated as acceptable by 69% in the lozenge group compared with 39% in the oral solution group (P = 0.0092). The taste was evaluated as good by 78% in the lozenge group (P < 0.0001), and 82% found the lozenge to have good texture (P < 0.0001).Conclusion: The lozenge reduced the gag reflex, diminished patients’ discomfort during UGE, and was evaluated as having a good taste and texture. The lozenge improved patients’ acceptance of UGE.Keywords: upper gastrointestinal endoscopy, topical pharyngeal anesthetic, lidocaine lozenge