Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
Gastrointest Endosc. 2020 Aug;92(2):293-300. doi: 10.1016/j.gie.2020.02.050. Epub 2020 Mar 7.
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.
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.
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.
Intravenous lidocaine can significantly decrease propofol requirements during ERCP, with higher sedation quality and endoscopist satisfaction. (Clinical trial registration number: NCT03996577.).
依托咪酯镇静在 ERCP 操作中被广泛应用，但常发生不良的呼吸或心血管事件。静脉注射利多卡因具有镇痛作用，并能减少腹部手术中芬太尼和依托咪酯的需求。本研究旨在评估 ERCP 操作中静脉注射利多卡因对依托咪酯需求的影响。
48 例行 ERCP 的患者被随机分为 2 组，利多卡因组和对照组。所有患者静脉注射咪达唑仑 0.02 mg/kg 和舒芬太尼 0.1 μg/kg 作为术前用药。给予依托咪酯推注诱导镇静，然后持续输注依托咪酯维持。利多卡因组患者静脉注射 1.5 mg/kg 利多卡因负荷量，然后以 2 mg/kg/h 的速度持续输注，而对照组患者给予相同容量的生理盐水。主要结局为 ERCP 期间的依托咪酯需求。
与对照组相比，利多卡因组的依托咪酯需求减少了 33.8%（212.0 ± 118.2 mg 比 320.0 ± 189.6 mg，P =.023）。不自主运动在利多卡因组比对照组更少见（12.5%比 41.7%，P =.049）。在利多卡因组，术后疼痛和疲劳的视觉模拟评分明显降低（0 [范围，0-4] 比 3 [范围，0-5]，P =.005；2 [范围，0-4] 比 5 [范围，2-8]，P <.001）。利多卡因组的氧饱和度下降、低血压和心动过缓的发生率也较低。
静脉注射利多卡因可显著降低 ERCP 期间依托咪酯的需求，同时提高镇静质量和内镜医师满意度。（临床试验注册号：NCT03996577.）。
