Department of Anaesthesiology, CHU Liège, University of Liège, Domaine du Sart Tilman, Liège, Belgium.
Department of Algology and Palliative Care, CHU Liège, University Hospital of Liège, Domaine du Sart Tilman, Liège, Belgium; GIGA Consciousness, Sensation and Perception Research Group, University of Liège, Liège, Belgium.
Br J Anaesth. 2018 Nov;121(5):1059-1064. doi: 10.1016/j.bja.2018.06.019. Epub 2018 Aug 1.
Propofol use during sedation for colonoscopy can result in cardiopulmonary complications. Intravenous lidocaine can alleviate visceral pain and decrease propofol requirements during surgery. We tested the hypothesis that i.v. lidocaine reduces propofol requirements during colonoscopy and improves post-colonoscopy recovery.
Forty patients undergoing colonoscopy were included in this randomised placebo-controlled study. After titration of propofol to produce unconsciousness, patients were given i.v. lidocaine (1.5 mg kg then 4 mg kg h) or the same volume of saline. Sedation was standardised and combined propofol and ketamine. The primary endpoint was propofol requirements. Secondary endpoints were: number of oxygen desaturation episodes, endoscopists' working conditions, discharge time to the recovery room, post-colonoscopy pain, fatigue.
Lidocaine infusion resulted in a significant reduction in propofol requirements: 58 (47) vs 121 (109) mg (P=0.02). Doses of ketamine were similar in the two groups: 19 (2) vs 20 (3) mg in the lidocaine and saline groups, respectively. Number of episodes of oxygen desaturation, endoscopists' comfort, and times for discharge to the recovery room were similar in both groups. Post-colonoscopy pain (P<0.01) and fatigue (P=0.03) were significantly lower in the lidocaine group.
Intravenous infusion of lidocaine resulted in a 50% reduction in propofol dose requirements during colonoscopy. Immediate post-colonoscopy pain and fatigue were also improved by lidocaine.
NCT 02784860.
镇静状态下进行结肠镜检查时使用异丙酚可能导致心肺并发症。静脉内利多卡因可减轻内脏疼痛并减少手术过程中的异丙酚需求。我们检验了静脉内利多卡因可减少结肠镜检查期间异丙酚的需求并改善结肠镜检查后恢复的假设。
本随机安慰剂对照研究纳入了 40 名接受结肠镜检查的患者。在异丙酚滴定至产生无意识后，患者接受静脉内利多卡因（1.5mg/kg 然后 4mg/kg/h）或相同体积的生理盐水。镇静标准化并与异丙酚和氯胺酮联合使用。主要终点是异丙酚的需求。次要终点是：氧气饱和度下降发作次数、内镜医师的工作条件、恢复室出院时间、结肠镜检查后疼痛、疲劳。
利多卡因输注导致异丙酚需求显著降低：58（47）与 121（109）mg（P=0.02）。两组的氯胺酮剂量相似：利多卡因组和生理盐水组分别为 19（2）与 20（3）mg。两组的氧气饱和度下降发作次数、内镜医师的舒适度和恢复室出院时间相似。利多卡因组的结肠镜检查后疼痛（P<0.01）和疲劳（P=0.03）明显降低。
静脉内输注利多卡因可使结肠镜检查期间异丙酚的剂量需求降低 50%。利多卡因还可改善结肠镜检查后的即时疼痛和疲劳。
NCT 02784860。
