Clinical and Experimental Gastroenterology (May 2021)
Comparison of Lidocaine Spray and Lidocaine Ice Popsicle in Patients Undergoing Unsedated Esophagogastroduodenoscopy: A Single Center Prospective Randomized Controlled Trial
Abstract
Prasit Mahawongkajit,1 Nantawat Talalak,1 Neranchala Soonthornkes2 1Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Thammasat University, Pathumthani, 12120, ThailandCorrespondence: Prasit MahawongkajitDepartment of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 99/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, ThailandTel +66 2926 9523Fax +66 2926 9530Email [email protected]: Esophagogastroduodenoscopy (EGD) under topical pharyngeal anesthesia has the advantage of avoiding the unwanted cardiopulmonary adverse events experienced following intravenous sedation. Lidocaine spray is a common anesthetic option and is safe for unsedated EGD. Although several studies have compared different topical anesthetic agents, their formulations, and delivery techniques, questions still remain concerning the optimal mode of administration. We have designed a lidocaine formulation in the form of an ice popsicle and compared its effectiveness and tolerability with lidocaine spray in patients undergoing unsedated EGD.Methods: This was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray [Group (Gp) A] or lidocaine ice popsicle (Gp B) formulation.Results: In total, 204 unsedated EGD patients were evaluated. Compared to the spray, the lidocaine ice popsicle group showed better scores for effects in terms of endoscopist satisfaction (Gp A, 7.28± 1.44; Gp B, 7.8± 0.89; p=0.0022), gag reflex (Gp A, 1.3± 0.66; Gp B, 1.02± 0.61; p=0.0016), patient satisfaction (Gp A, 7.74± 0.82; Gp B, 8.08± 0.82; p=0.0039), discomfort (Gp A, 6.54± 1.34; Gp B, 5.95± 1.21; p=0.0012), and pain (Gp A, 5.38± 1.85; Gp B, 4.51± 2.01; p=0.0015).Conclusion: Both the lidocaine spray and ice popsicle formulations are safe, effective options for diagnostic EGD with the ice popsicle exhibiting better performance. We propose the lidocaine ice popsicle formulation for topical pharyngeal anesthesia in patients undergoing unsedated diagnostic EGD and suggest it may be a suitable option during the COVID-19 pandemic.Clinical Trial Register: Thai Clinical Trials Registry (TCTR) number TCTR20190502001.Keywords: lidocaine spray, lidocaine ice popsicle, esophagogastroduodenoscopy, upper gastrointestinal endoscopy, topical pharyngeal anesthesia
