Comparison of Lidocaine Spray and Lidocaine Ice Popsicle in Patients Undergoing Unsedated Esophagogastroduodenoscopy: A Single Center Prospective Randomized Controlled Trial

Prasit Mahawongkajit, Nantawat Talalak, Neranchala Soonthornkes, Prasit Mahawongkajit, Nantawat Talalak, Neranchala Soonthornkes

Abstract

Purpose: 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: esophagogastroduodenoscopy; lidocaine ice popsicle; lidocaine spray; topical pharyngeal anesthesia; upper gastrointestinal endoscopy.

Conflict of interest statement

The authors report no conflicts of interest or financial ties to disclose.

© 2021 Mahawongkajit et al.

Figures

Figure 1
Figure 1
Lidocaine ice popsicle. The lidocaine ice popsicle made by viscous lidocaine solution 20 mg/mL, 6 mL with a stick in the silicone mold. It is stored overnight in the freezer to the day of endoscopy.
Figure 2
Figure 2
CONSORT flow diagram.

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