Intravenous Lidocaine Significantly Reduces the Propofol Dose in Elderly Patients Undergoing Gastroscopy: A Randomized Controlled Trial

Drug Des Devel Ther. 2022 Aug 12:16:2695-2705. doi: 10.2147/DDDT.S377237. eCollection 2022.

Abstract

Objective: Propofol-based sedation has been widely used for gastroscopy, but the risk of respiratory suppression in elderly patients should not be overlooked. Intravenous (IV) lidocaine during surgery can reduce the demand for propofol and the incidence of cardiopulmonary complications. We examined whether IV lidocaine reduces the dose of propofol and the occurrence of adverse events during gastroscopy in elderly patients.

Methods: We conducted a prospective, single-center, double-blind randomized controlled trial in elderly patients aged ≥65 years with ASA I-II. Subjects were randomly assigned to the lidocaine group (Group L, n=70), who received IV 1.5 mg kg-1 lidocaine followed by a continuous infusion of 4 mg kg-1 h-1 lidocaine, or the normal saline group (Group N, n=70), who received an equal volume of saline in the same way.

Results: IV lidocaine reduced the total and maintenance propofol dose in Group L (p<0.001), with no significant effect on the induction dose. The incidence of intraoperative hypoxia (p=0.035), emergency airway management events (p=0.005), duration of gastroscopy (p<0.05), consciousness recovery time (p<0.001), and postoperative pain (p=0.009) were all reduced in Group L. Patient (p=0.025) and gastroscopist (p=0.031) satisfaction was higher in Group L. Intraoperative hemodynamic parameters, the respiratory rate, the incidence of sedation-related events and anesthesiologist satisfaction were similar between the two groups.

Conclusion: IV lidocaine can significantly reduce the amount of propofol, the incidence of hypoxia and postoperative pain during gastroscopy in elderly patients, with a higher patient and gastroscopist satisfaction.

Keywords: elderly patient; gastroscopy; lidocaine; propofol; sedation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anesthetics, Intravenous / adverse effects
  • Anesthetics, Local
  • Double-Blind Method
  • Gastroscopy
  • Humans
  • Hypoxia / drug therapy
  • Lidocaine*
  • Pain, Postoperative / drug therapy
  • Propofol* / adverse effects
  • Prospective Studies

Substances

  • Anesthetics, Intravenous
  • Anesthetics, Local
  • Lidocaine
  • Propofol

Grants and funding

This study was supported by the Program of Shanghai Academic Research Leader (No.21XD1402800); Shanghai “Rising Stars of Medical Talent” Youth Development Program: Outstanding Youth Medical Talents; the Young Elite Scientist Sponsorship Program by CAST (2018QNRC001); Shanghai Pujiang Program(2020PJD050); Academic medicine leader’s training Program in health systems of Pudong New Area(PWRd2020-06), the Basic Research Program for Young Elite Scientist by Shanghai Association for the Study of Pain(2018SASP01); the Research Program for Young Scientist by Shanghai Society of Anesthesiology (2019SSA).