Efficacy and safety of intravenous lidocaine in propofol-based sedation for ERCP procedures: a prospective, randomized, double-blinded, controlled trial.

Propofol-based sedations are 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 0.02 mg/kg midazolam and 0.1 μg/kg sufentanil intravenously as premedication. A bolus of propofol was applied for induction of sedation, and perfusion of propofol was applied for maintenance. The 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, the propofol requirements were reduced by 33.8% in the lidocaine group (212.0±118.2 mg vs 320.0±189.6 mg, p=0.023). Involuntary movement was less common in the lidocaine group than in the control group (12.5% vs 41.7%, p=0.049). In the lidocaine group, postprocedure pain and fatigue were significantly reduced (0 [0-4] vs 3 [0-5], p=0.005; 2 [0-4] vs 5 [2-8], p<0.001).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.