Effects of propofol infusion with and without lidocaine on pain and need for sedation during Endoscopic Retrograde Cholangio Pancreatography(ERCP)

Abstract

Due to its visceral analgesic effect without respiratory and cardiac depression in the recommended dose, lidocaine can be a very promising auxiliary drug for ERCP sedation. A review of the literature indicates the beneficial effects of intravenous lidocaine in reducing pain intensity and satisfaction during surgery; However, due to the lack of studies on the infusion of this drug during ERCP and the need for strong evidence about the effects of this method, it is necessary to conduct the present study. However, data focused on the use of intravenous lidocaine in deep sedation during ERCP are still lacking. This study aimed to investigate the effect of intravenous lidocaine in deep sedation during ERCP Methods: For patients in the intervention group, they received 1.5 mg of lidocaine per kilogram of weight, and then they received 4 mg of lidocaine per kilogram of weight in one hour as an infusion, and for patients in the control group, The same volume of normal saline was also infused. Propofol injection was performed as a bolus as follows: for patients over 75 years of age, propofol was injected at the rate of 0.25 mg per kilogram of weight. For patients between 75 and 40 years of age, propofol was injected at the rate of 0.50 mg per kilogram of weight. For patients less than 40 years of age, propofol was injected at the rate of 0.75 mg per kilogram of weight. Then, propofol was given as a propofol infusion at a rate of 2 to 4 mg per kilogram of weight per hour. Also, in case of pain, poor cooperation and dissatisfaction of the doctor performing ERCP, propofol was injected as a bolus at a rate of 0.5 mg per kilogram of weight. Results: Propofol induction in the intervention group was significantly lower than the control group (P=0.044); It was also found that the maintenance dose of propofol was significantly higher in the control group than in the intervention group (P=0.036); Finally, it was found that the total propofol injected in the patients of the intervention group was significantly lower than the control group (P=0.033). The duration of induction (P=0.035) and the length of surgery (P=0.025) in the intervention group were significantly less than the control group, while the duration of recovery in the patients of the intervention group was significantly longer than the control group. P=0.044). Finally, it was found that the doctor's satisfaction with the procedure performed and the comfort in performing the procedure in patients of the intervention group was significantly higher than the control group (P=0.011).