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Comparative effectiveness of lidocaine sprays between sitting and supine position for patients undergoing upper gastrointestinal endoscopy: a prospective randomized controlled trial

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Abstract

Background

Topical pharyngeal anesthesia has improved esophagogastroduodenoscopy (EGD) efficiency with smooth insertion, reducing pain and discomfort. Lidocaine spray is one of the safe and widely used methods. In practice, the patients walk, sit in a wheelchair, or lie on a trolley bed, and the lidocaine sprays are applied to those in sitting or supine positions for pre-endoscopic preparation. Although there is no current guidance technique, this study aims to compare the effects of lidocaine sprays between sitting (Group A; Gp A) and supine positions (Group B; Gp B) for patients undergoing unsedated EGD.

Methods

This study was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray in sitting or lidocaine spray in the supine position.

Results

Lidocaine spray treatments were significantly different in the gag reflex (NRS; Gp A: 1.28 ± 0.67, Gp B: 1 ± 0.63, p = 0.0003), ease of esophageal instrumentation (NRS; Gp A: 7.68 ± 0.91, Gp B: 7.95 ± 0.66, p = 0.0042), and pain score (NRS; Gp A: 5.16 ± 2.08, Gp B: 4.53 ± 1.93, p = 0.0059). When considering modified Mallampati classification (MMC), MMC classes III and IV were significantly different in the same direction but MMC classes I and II were not.

Conclusion

The technique of spraying in the supine position was associated with less gagging, less pain, and easier esophageal instrumentation, especially in patients with MMC classes III and IV.

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Data availability

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by Research Group in Surgery, Faculty of Medicine, Thammasat University. Special thanks to Norman Mangnall for assistance in editing the English version of this paper and Dr. Saritphat Orrapin for scrutinizing methodology.

Funding

This research was supported in part by Thammasat University.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, Thailand

    Prasit Mahawongkajit

  2. Department of Anesthesiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand

    Neranchala Soonthornkes

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  1. Prasit Mahawongkajit
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All authors contributed to data analysis, drafting, and revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

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Correspondence to Prasit Mahawongkajit.

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Dr. Prasit Mahawongkajit and Dr. Neranchala Soonthornkes have no conflicts of interest or financial ties to disclose.

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Mahawongkajit, P., Soonthornkes, N. Comparative effectiveness of lidocaine sprays between sitting and supine position for patients undergoing upper gastrointestinal endoscopy: a prospective randomized controlled trial. Surg Endosc 36, 5067–5075 (2022). https://doi.org/10.1007/s00464-021-08868-2

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  • DOI: https://doi.org/10.1007/s00464-021-08868-2

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