A clinical trial Comparison of the Effect of Propofol Plus IV Lidocaine versus Propofol Plus Topical Lidocaine Spray on Decreasing Gag Reflex in Upper GI Endoscopy: A Clinical Trial

Upper GI endoscopy is a diagnostic and therapeutic procedure widely used across the world. Some patients, however, experience a great deal of discomfort during the procedure, which is mainly due to activation of the gag reflex. Therefore, topical pharyngeal or general anesthesia is applied to reduce the gag reflex during endoscopy. This study aimed to compare the effect of IV lidocaine versus topical lidocaine spray in reducing the gag reflex in patients sedated with propofol.

This randomized clinical trial was conducted in Imam Khomeini Hospital in 2017. One group of patients received propofol at a dose of 0.5-1 mg/kg plus lidocaine spray and the other group received propofol at the same dose plus IV lidocaine at a dose of 1 mg/kg (maximum 100 mg). Patients in both groups also received 50 µg fentanyl. The variables of gag reflex (using the VAS), patient and physician satisfaction, length of endoscopy, vital signs, and adverse effects were compared between the two groups.

Ninety-three patients were evaluated in this study, of whom 42 (45.2%) were men and the rest were women (n=51, 54.8%). ANOVA was used to evaluate the effect of type of anesthesia on the final level of gag reflex and the results showed lack of any significant difference between the two groups (P>0.05). Patient satisfaction was higher in the IV anesthesia group (P= 0.036) and the physician satisfaction was higher in the topical anesthesia group (P= 0.027). Among vital signs, only SBP showed a modest difference between the two groups and was significantly higher in the topical anesthesia group (P=0.04). There was no significant difference in the rate of adverse effects between the two groups (P> 0.05).

Topical anesthesia using lidocaine spray is as effective and safe as IV lidocaine in decreasing the gag reflex in upper GI endoscopy in patients sedated with propofol.