| Aim:Lidocaine is a effective anesthetic drug,which has become a universally understanding in local pharyngeal anesthesia during common gastroscopy.However,with the increase of painless gastroscopy,whether lidocaine with local pharyngeal anesthesia routinely has not conclusion during painless gastroscopy.In additional,there are related studies about intravenous lidocaine(IVL)during painless gastroscopy in recently.but it is not recommend in relevant guidelines.therefore,This study was aimed to evaluate the safety and efficacy of lidocaine in pharyngeal anesthesia and intravenous during painless gastroscopy by a systematic review and meta-analysis.Methods:The randomized controlled trials(RCTs)about the safety and efficacy of lidocaine in pharyngeal anesthesia and intravenous during painless gastroscopy were searched by The Cochrane Central Register of Controlled Trials,Embase,PubMed.CBM,CNKI,VIP and WanFang Databases,since the establishment of The Database to January 1,2021.According to the exclusion criteria and inclusion,Studies were selected.Stata 16.0,RevMan 5.41 and EndNote X9 was used to data analysis and management.According to Random Effects Model or Fixed Effects Model which based on heterogeneity date was collected.The outcomes included nausea and/or vomiting.propofol injection pain,total dosage of propofol,pharyngeal discomfort and/or pain.hypoxemia or apnea,heart rate(HR),etc.Results:We included seventeen RCTs with 2336 patients,which included 1172 patients in the control group and 1164 in experimental group.Lidocaine reduced the risk of nausea and/or vomiting than the control group in pharyngeal anesthesia during sedative gastroscopy(RR=0.59.95%CI[0.39,0.89];P=0.01<0.05),while cannot reduce nausea and/or vomiting in intravenous anesthesia(RR=1.15,95%CI[0.34,1.34];P=0.65>0.05);compared to the control group lidocaine decreased the incidence of propofol injection pain(RR=0.52,95%CI[0.44,0.62],P<0.001)during Intravenous induced anesthesia;We found that the total dose of propofol administered was significantly lower in the lidocaine group than the control group(SMD=-1.05,95%CI[-1.99,-0.11],P=0.03<0.05),while lidocaine combined with pharyngeal anesthesia could not reduce the total amount of propofol(SMD=0.02,95%CI[-0.13,0.18],P=0.79>0.05);lidocaine with pharyngeal anesthesia can reduced the incidence of pharyngeal discomfort and/or pain(RR=0.08,95%CI[0.01,0.73],P=0.02<0.05);however it did not reduce the incidence of pharyngeal discomfort and/or pain in intravenous anesthesia(RR=0.60,95%CI[0.27,1.37],P=0.23>0.05);Lidocaine cannot increase the incidence of hypoxemia compared with the control group(RR=0.77,95%CI[0.44,1.32],P=0.34>0.05);Lidocaine can not reduce the incidence of body movement(RR=0.59,95%CI[0.33,1.08],P=0.09>0.05);The lidocaine group had a little effect on MAP(MD=4.17,95%CI[2.95,5.39],P<0.001);The combination of intravenous lidocaine did not reduce heart rate compared with the control group(MD=0.72,95%CI[-0.79,2.23],P=0.35>0.05).Conclusion:This study preliminary validation lidocaine with pharyngeal anesthesia not only can reduce the risk of nausea and/or vomiting,but also can relieve pharyngeal discomfort or pain during gastroscopic procedures,so it is recommended to use routinely.lidocaine with intravenous assisted anesthesia can decreases the doses of propofol and the incidence of injection pain during gastroscopic endoscopic procedures.at the same time it does not increase the risk of adverse events significantly in patient’s.lidocaine with supplemental intravenous have better effect and safety for sedation in gastroscopic procedures.However,all of the included study were single-center and part of them samples were small that needed more studies with multi-center and larger sample to evaluate in the further. |
PDF Full Text Request