IV lidocaine eases endoscopic submucosal dissection for gastric neoplasm

Reuters Health Information: IV lidocaine eases endoscopic submucosal dissection for gastric neoplasm

IV lidocaine eases endoscopic submucosal dissection for gastric neoplasm

Last Updated: 2016-05-13

By Will Boggs MD

NEW YORK (Reuters Health) - IV lidocaine decreases patient movement and reduces pain during endoscopic submucosal dissection (ESD) for gastric neoplasm, researchers report.

"IV lidocaine already has been used in various surgical settings without increasing adverse effects," Dr. So Yeon Kim from Yonsei University College of Medicine, Seoul, Korea told Reuters Health by email. "Therefore, there is no need for hesitating use of IV lidocaine during ESD because the safety is already proven. We recommend use of IV lidocaine as a bolus of 1.5 mg/kg and then as a continuous infusion of 2 mg/kg/h as additional options for sedative drugs for ESD."

ESD is commonly used to treat premalignant lesions and early stomach cancers, and several studies have reported methods for reducing pain during and after the procedure.

Dr. Kim's team assessed the effects of IV lidocaine on sedative and analgesic requirements during ESD and on post-ESD pain in a randomized, placebo-controlled study of 66 patients with early gastric neoplasm.

Sedation after propofol and fentanyl boluses occurred significantly faster in the lidocaine group (median, 40 seconds) than in the saline/placebo group (median, 55 seconds), according to the May issue of Medicine.

The total dose of fentanyl during the procedure was 24% lower and the total dose of propofol was 18% lower in the lidocaine group than in the control group.

"ESD is performed under sedation, not under general anesthesia; thus, it is important to maintain self-respiration of patients during ESD," Dr. Kim explained. "Fentanyl and propofol can induce respiratory depression; therefore, reducing doses of these is more important in the setting of ESD than surgery settings which are performed under general anesthesia."

Only 3% of patients in the lidocaine group had involuntary movement during the procedure, compared with 26% of patients in the control group.

Epigastric pain at 6 hours after ESD was rated significantly lower by lidocaine patients than by control patients, and the incidence of throat pain was also significantly lower in the lidocaine group (27% vs 65%).

Complications after the procedure were similar between the treatment groups, and there were no cardiovascular or neurological side effects associated with IV lidocaine.

"We do not recommend routine use of lidocaine," Dr. Kim said. "Instead we recommend (it) for patients with high risk of respiratory depression (e.g., snoring history, obesity) or procedure that takes longer time (because in this case high doses of fentanyl and propofol are needed, which can result in respiratory depression)."

Dr. Shinsuke Kiriyama from National Cancer Center Hospital, Tokyo, Japan told Reuters Health by email, "Lidocaine has local analgesic effect, so we use as local injection to gastric submucosal layer, not intravenous."

Before using IV lidocaine during ESD, Dr. Kiriyama would like to see "additional reports about effects and toxicity of intravenous lidocaine using this method/setting."

SOURCE: http://bit.ly/1Os8Jlr

Medicine 2016.

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