Rinaldi Pasquale, Galderisi Andrea, Lamacchia Elena Maria, Di Folco Marta, Strumia Alessandro, Lavorante Fedra, Mattei Alessia, Schiavoni Lorenzo, Pascarella Giuseppe, Cataldo Rita, Carassiti Massimiliano, Agrò Felice Eugenio, Garo Maria Luisa
Anaesthesia and Intensive Care Research Unit, Campus Bio-Medico University, Rome, Italy; Department of Anaesthesiology, Unit of Emergency Anaesthesia, Burn Intensive Care and Poison Control Center, AORN Antonio Cardarelli, Naples, Italy.
Anaesthesia and Intensive Care Research Unit, Campus Bio-Medico University, Rome, Italy.
J Clin Anesth. 2025 Sep;106:111960. doi: 10.1016/j.jclinane.2025.111960. Epub 2025 Aug 9.
Sedation during endoscopic gastrointestinal procedures is now a routine practise that can improve patient outcomes. Propofol is one of the most commonly used intravenous anaesthetics. However, despite its popularity, it has been associated with various side effects, particularly haemodynamic and respiratory complications, especially in frail patient populations. Intravenous (IV) lidocaine, used as an adjuvant, has already demonstrated its efficacy in improving certain outcomes during sedation with propofol. However, the emergence of further studies requires an update to enhance the quality of existing data and refine this anaesthetic practise. The aim of this systematic review and meta-analysis is to evaluate the efficacy of intravenous lidocaine in reducing propofol consumption, decreasing episodes of desaturation and involuntary movements during the procedure, improving awakening time, relieving post-procedure pain, and increasing endoscopist satisfaction during propofol sedation in gastrointestinal endoscopic procedures (PROSPERO registration: CRD420250651511).
We included randomised controlled trials conducted in adult patients undergoing propofol sedation with IV lidocaine administered as an adjunct during gastrointestinal endoscopic procedures. A comprehensive systematic search was conducted in PubMed/MEDLINE, Scopus and Web of Science from January to February 2025 without language or time restrictions. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2).
Seventeen randomised controlled trials (1698 patients) were selected based on full text and included in the study. Lower propofol consumption was observed with intravenous lidocaine compared with the control group (SMD: -1.36, 95 % CI: -1.67 to -1.05; p < 0.001), with consistent results in all subgroups. Awakening time was significantly shorter in the IV lidocaine group (SMD = -0.92 [95 % CI: -1.18 to -0.66]; p < 0.001), while no significant difference was observed in full recovery time. Lidocaine administration was associated with a 59 % reduction in desaturation events, 36 % reduction in hypotension events and a 57 % reduction in involuntary movements. Continuous infusion after bolus administration was required to achieve these effects. Infusion rates of 2 mg/kg/h and 4 mg/kg/h were equally effective.
Intravenous lidocaine is a safe and effective adjunct to propofol sedation in gastrointestinal endoscopy, reducing anaesthetic requirements and sedation-related complications. Routine use of lidocaine may increase the safety of the procedure, especially in high-risk populations and complex procedures.
在内镜下胃肠道手术中进行镇静现已成为一种常规操作，可改善患者预后。丙泊酚是最常用的静脉麻醉剂之一。然而，尽管它很受欢迎，但它与各种副作用有关，特别是血流动力学和呼吸并发症，尤其是在体弱患者群体中。静脉注射利多卡因作为辅助药物，已证明其在丙泊酚镇静过程中改善某些预后方面的有效性。然而，进一步研究的出现需要更新以提高现有数据的质量并完善这种麻醉方法。本系统评价和荟萃分析的目的是评估静脉注射利多卡因在减少丙泊酚用量、减少手术过程中血氧饱和度下降和不自主运动的发生率、改善苏醒时间、减轻术后疼痛以及提高内镜医师在胃肠道内镜手术丙泊酚镇静过程中的满意度方面的有效性（国际前瞻性系统评价注册库注册号：CRD420250651511）。
我们纳入了在胃肠道内镜手术期间接受丙泊酚镇静并静脉注射利多卡因作为辅助药物的成年患者中进行的随机对照试验。于2025年1月至2月在PubMed/MEDLINE、Scopus和Web of Science中进行了全面的系统检索，无语言或时间限制。使用Cochrane偏倚风险工具（RoB2）评估偏倚风险。
根据全文筛选出17项随机对照试验（1698例患者）并纳入研究。与对照组相比，静脉注射利多卡因时丙泊酚用量更低（标准化均数差：-1.36，95%置信区间：-1.67至-1.05；p<0.001），所有亚组结果一致。静脉注射利多卡因组的苏醒时间显著缩短（标准化均数差=-0.92[95%置信区间：-1.18至-0.66]；p<0.001），而完全恢复时间未观察到显著差异。利多卡因给药与血氧饱和度下降事件减少59%、低血压事件减少36%和不自主运动减少57%相关。推注后需要持续输注才能达到这些效果。2mg/kg/h和4mg/kg/h的输注速率同样有效。
静脉注射利多卡因是胃肠道内镜检查中丙泊酚镇静的一种安全有效的辅助药物，可降低麻醉需求和与镇静相关的并发症。常规使用利多卡因可能会提高手术的安全性，尤其是在高危人群和复杂手术中。
