Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy

Area of Science:

• Gastroenterology
• Anesthesiology
• Pharmacology

Background:

• Conscious sedation for esophagogastroduodenoscopy (EGD) typically uses benzodiazepines and opiates, carrying risks of adverse effects.
• Topical oropharyngeal anesthetics, like lidocaine, may improve EGD tolerance.
• Lidocaine administered via lollipop has shown efficacy in other procedures like endotracheal intubation.

Purpose of the Study:

• To assess the safety and efficacy of a lidocaine lollipop as a sole anesthetic for EGD.
• To determine if the lidocaine lollipop reduces the requirement for intravenous sedatives and analgesics during EGD.

Main Methods:

• A single-blinded, randomized, prospective study conducted in a university hospital setting.
• Fifty patients undergoing diagnostic EGD were randomized to receive either a lidocaine lollipop or a lidocaine spray.
• The primary outcome measured was the success and safety of local anesthesia, alongside the need for intravenous sedation.

Main Results:

• The lidocaine lollipop group experienced less gag reflex, easier scope introduction, and better overall tolerance compared to the spray group.
• A significantly lower percentage of patients in the lollipop group (32%) required intravenous sedation versus the spray group (96%) (P < .001).
• A majority of patients in the lidocaine lollipop group reported satisfaction with their anesthesia method.

Conclusions:

• The lidocaine lollipop represents a promising topical oropharyngeal anesthetic for EGD.
• Its use significantly decreases the need for intravenous sedation, enhancing safety and tolerability.
• This method is particularly beneficial for elderly patients, those with comorbidities, and in office-based endoscopy settings.