A research team from the American University of Beirut Medical Centre (AUBMC) in Lebanon has developed a lollipop containing the local anaesthetic lidocaine as a single-agent anesthetic to patients undergoing an upper gastrointestinal (GI) endoscopy procedure, which eliminates the need for sedation in the majority of patients.
Lollipops have been successfully used to provide anesthesia to children before painful procedures. The concept of using a lidocaine lollipop as a single-agent anesthetic in upper endoscopy is novel and has not been reported in medical literature. Medications to achieve sedation, however, may cause potential side effects such as respiratory depression, hypotension (low blood pressure) and paradoxical agitation, in which the patient becomes agitated rather than sleepy from the sedation. These side effects happen more so in elderly patients and those with comorbid illnesses. A study, published in the October issue of Gastrointestinal Endoscopy, the team found that administering the lidocaine lollipop eliminated the need for sedation in the majority of patients undergoing an upper gastrointestinal endoscopy procedure and was more effective than a lidocaine nasal spray. Such procedures are often done under sedation to provide patient comfort in order to examine the lining of the upper GI tract.
Upper endoscopy allows physicians to examine the lining of the upper part of the GI tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). It is often done under sedation to assure patient comfort. Upper endoscopy helps physicians evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is the best test for finding the cause of bleeding from the upper GI tract and is also more accurate than X-rays for detecting inflammation, ulcers, and tumors of the esophagus, stomach, and duodenum.
However, the results of the study found the use of the lollipop eliminated the need for intravenous sedation in nearly two thirds of patients and the use of lower doses of sedatives in the rest. Lidocaine has been on the market for almost 60 years and is available as an injected local anaesthetic, dermal patch, intravenous injection, nasal spray, oral gel and liquid, and formulated as a topical application.
The lollipop used in the study was developed by the anaesthesia department in collaboration with the pharmacy department at AUBMC. Fifty grams of white sugar was heated until liquefied and an equal amount of golden syrup was slowly added. For each lollipop, 3ml of this mixture was poured into a small cylindrical container, to which 300mg of lidocaine hydrochloride salt was added. As the mixture cooled and solidified, a small plastic stick was stuck in.
The researchers speculated that based on the positive results the use of such lollipops would probably lead to lower rates of adverse events requiring interventions and hence lower direct and indirect costs of the procedure. The researchers also noted the patients would require less recovery time after the procedure.
Fifty patients, 18 years of age and older with no allergies to lidocaine, were seen at the American University of Beirut Medical Center for elective diagnostic upper endoscopy. The single-blinded study participants were randomly assigned to receive 300 mg of lidocaine in the form of either a lollipop or as a spray. In both study groups, the decision to administer intravenous sedation was based on the blinded endoscopist's assessment of patient discomfort (excessive gagging, retching, restlessness and combativeness) during any part of the procedure. Immediately after the procedure, the endoscopist filled in a questionnaire rating the quality of the procedure, the tolerability of the patient, the doses of additional sedatives used, and the level of the patient's gag reflex.
The lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. The majority of participants in the lollipop group were satisfied with their mode of anesthesia compared with the spray group. The use of the lollipop resulted in the elimination of the need for any intravenous sedation in nearly two thirds of patients and the use of lower doses of sedatives in the rest. Researchers speculate that this would probably lead to lower rates of adverse events requiring interventions and hence lower direct and indirect costs of the procedure. Moreover, patients would require less recovery time and observation after the procedure, and could go back to work without much lost productivity.
Researchers thought that the observed effectiveness of the lollipop could be explained by the continuous release of lidocaine from sucking the lollipop, in addition to swallowing the saliva mixed with the local anesthetic. It allowed for a homogenous and slow spread of the anesthetic providing ample time to exert its effect.