Intravenous lidocaine decreased the incidence of SRAEs for ERCP procedures in elderly frailty patients, a randomized controlled trial.
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Summary
In frail elderly undergoing ERCP, IV lidocaine (bolus plus infusion) halved sedation-related adverse events and reduced propofol requirements and pain scores, while improving satisfaction, without added toxicity.
Key Findings
- Composite SRAEs were significantly lower with lidocaine (21.86%) vs control (41.05%).
- Propofol consumption and postoperative VAS pain scores were significantly reduced in the lidocaine group.
- Both endoscopist and patient satisfaction scores were higher with lidocaine; no increase in lidocaine-related adverse events.
Clinical Implications
Consider IV lidocaine adjunct during ERCP sedation in frail elderly to reduce hypoxemia/desaturation and other SRAEs and to lower sedative dose; monitor using standard lidocaine safety precautions.
Why It Matters
Addresses a high-risk population with a pragmatic, easily implementable intervention that improves safety during a common advanced endoscopic procedure.
Limitations
- Single-country, likely single-center design may limit generalizability.
- Blinding details not specified; sedation and airway management practices may vary.
Future Directions
Multicenter trials comparing lidocaine with other opioid-sparing strategies and exploring optimal dosing, monitoring, and cost-effectiveness are warranted.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - Randomized controlled trial with clinically relevant outcomes.
- Study Design
- OTHER