Background and Aims

Propofol-based sedation is widely used in ERCP procedures, but adverse respiratory or cardiovascular events commonly occur. Intravenous injection of lidocaine has an analgesic effect and can reduce the requirements of fentanyl and propofol during abdominal surgery. The objective of this study was to assess the efficacy and safety of intravenous lidocaine on propofol requirements during ERCP procedures.

Methods

Forty-eight patients scheduled for ERCP were randomly divided into 2 groups, the lidocaine group and the control group. All patients received .02 mg/kg midazolam and .1 μg/kg sufentanil intravenously as premedication. A bolus of propofol was applied for induction of sedation, and perfusion of propofol was applied for maintenance. Patients in the lidocaine group received a bolus of 1.5 mg/kg lidocaine intravenously followed by continuous infusion of 2 mg/kg/h, whereas the control group received the same volumes of saline solution. The primary outcome was the propofol requirement during ERCP.

Results

Compared with the control group, propofol requirements were reduced by 33.8% in the lidocaine group (212.0 ± 118.2 mg vs 320.0 ± 189.6 mg, P = .023). Involuntary movement was less common in the lidocaine group than in the control group (12.5% vs 41.7%, P = .049). In the lidocaine group, postprocedure pain and fatigue, as measured by the visual analog scale, were significantly reduced (0 [range, 0-4] vs 3 [range, 0-5], P = .005; 2 [range, 0-4] vs 5 [range, 2-8], P < .001).The incidence of oxygen desaturation, hypotension, and bradycardia tended to be lower in the lidocaine group.

Conclusions

Intravenous lidocaine can significantly decrease propofol requirements during ERCP, with higher sedation quality and endoscopist satisfaction. (Clinical trial registration number: NCT03996577.)

中文翻译：

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静脉利多卡因在基于异丙酚的镇静中用于ERCP手术的功效和安全性：一项前瞻性，随机，双盲，对照试验。

背景和目标

基于异丙酚的镇静剂广泛用于ERCP手术，但通常会发生不利的呼吸或心血管事件。静脉注射利多卡因具有镇痛作用，可以减少腹部手术中对芬太尼和丙泊酚的需要。这项研究的目的是评估ERCP手术过程中静脉注射利多卡因对异丙酚需求的疗效和安全性。

方法

预定接受ERCP治疗的48例患者随机分为两组，利多卡因组和对照组。所有患者均接受静脉注射0.02 mg / kg咪达唑仑和0.1μg/ kg舒芬太尼作为处方药。大剂量的异丙酚用于镇静，灌注的异丙酚用于维持。利多卡因组的患者静脉推注1.5 mg / kg利多卡因，然后连续输注2 mg / kg / h，而对照组则接受相同体积的盐溶液。主要结果是ERCP期间需要异丙酚。

结果

与对照组相比，利多卡因组丙泊酚需求量降低了33.8％（212.0±118.2 mg与320.0±189.6 mg，P = .023）。利多卡因组的非自愿运动较对照组 少见（12.5％比41.7％，P = .049）。在利多卡因组中，通过视觉模拟量表测得的术后疼痛和疲劳显着降低（0 [范围，0-4] vs 3 [范围，0-5]，P  = .005； 2 [范围，0 -4] vs 5 [范围，2-8]，P  <.001）。利多卡因组氧饱和度降低，低血压和心动过缓的发生率较低。

结论

利多卡因静脉注射可显着降低ERCP期间的丙泊酚需求量，具有更高的镇静质量和内镜医师满意度。（临床试验注册号：NCT03996577。）