Lidocaine Spray Versus Viscous Lidocaine Solution Plus Lidocaine Spray in Patients Undergoing Non-Sedated Esophagogastroduodenoscopy: A Randomized Controlled Trial.

Combining lidocaine spray with viscous lidocaine solution significantly reduced procedural discomfort and improved conditions during non-sedated EGD compared to lidocaine spray alone.

Summary and findings

This study measured procedural pain and satisfaction in 250 patients undergoing non-sedated esophagogastroduodenoscopy (EGD) comparing lidocaine spray alone with a combination of lidocaine spray and viscous lidocaine solution. The primary outcome was procedural pain measured using a visual analog scale (VAS). The combination group reported lower pain levels and higher satisfaction compared to the spray-only group.

Abstract

<h4>Background</h4>Non-sedated esophagogastroduodenoscopy (EGD) is preferred in patients at risk from sedatives. However, achieving effective pharyngeal anesthesia remains a challenge. This study compared lidocaine spray alone with a combination of lidocaine spray and viscous lidocaine solution.<h4>Methods</h4>This single-center, randomized controlled trial was conducted between January 2024 and October 2024 at Sawanpracharak Hospital, Thailand. A total of 250 patients undergoing non-sedated EGD were randomized to receive lidocaine spray alone (S group, <i>n</i> = 125) or lidocaine spray plus viscous lidocaine (S + V group, <i>n</i> = 125). The primary outcome was procedural pain measured using a visual analog scale (VAS, 0-10) immediately after completion of the procedure. Secondary outcomes included patient satisfaction, endoscopist satisfaction, ease of intubation, tolerance, and adverse events.<h4>Results</h4>Baseline characteristics were comparable between groups. The S + V group reported significantly lower procedural pain than the S group (mean VAS 1.6 ± 1.1 vs. 3.1 ± 1.7; <i>p</i> = 0.01). Patient satisfaction was higher in the S + V group (very satisfied: 23.2% vs. 12.8%; <i>p</i> = 0.016). Ease of intubation was also improved (effortless intubation: 43.2% vs. 29.6%; <i>p</i> = 0.030). Endoscopist satisfaction numerically favored the S + V group but did not reach statistical significance (<i>p</i> = 0.070). No serious adverse events were observed.<h4>Conclusion</h4>Combining lidocaine spray with viscous lidocaine solution significantly reduced procedural discomfort and improved procedural conditions during non-sedated EGD compared with lidocaine spray alone.<h4>Trial registration</h4>ClinicalTrials.gov identifier: NCT06185933.

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