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Meta-Analysis
. 2021 May;33(4):538-548.
doi: 10.1111/den.13775. Epub 2020 Sep 21.

Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta-analysis

Jun Watanabe  1   2   3 , Yusuke Ikegami  4 , Ayumi Tsuda  2 , Eiichi Kakehi  5 , Takeshi Kanno  6 , Shizukiyo Ishikawa  1 , Yuki Kataoka  3   7
Affiliations
Meta-Analysis

Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta-analysis

Jun Watanabe et al. Dig Endosc. 2021 May.

Abstract

Objectives: There are two major methods for local anesthesia by lidocaine before upper gastrointestinal endoscopy: simple spray and viscous solution. We aimed to assess the efficacy and safety by meta-analysis between these two methods.

Methods: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases through October 2019 to perform meta-analyses using random-effects models. The primary outcomes were participants' pain/discomfort, satisfaction, and anaphylactic shock. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in PROSPERO (CRD42020155611).

Results: We included seven randomized controlled trials (2667 participants). The participants' pain/discomfort may be similar between the lidocaine spray and viscous solution [standardized mean difference 0.03, 95% confidence intervals (CI) -0.37 to 0.42; I2 = 93%; low certainty of evidence]. The lidocaine spray probably increased participants' satisfaction compared with the viscous solution (relative risk 1.22; 95% CI, 1.02 to 1.47; I2 = 47%; moderate certainty of evidence). No anaphylactic shock occurred in four studies (low certainty of evidence). Four studies had high risks of selection bias.

Conclusion: The use of lidocaine spray for local anesthesia provided better satisfaction scores than the viscous solution, and both methods have the same effect with regards to the control of discomfort and pain. Further studies in large multicenter randomized controlled trials with a pre-registration protocol are needed.

Keywords: endoscopy; lidocaine; oral sprays; systematic review; viscosity.

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Conflict of interest statement

Authors declare no conflicts of interest for this article.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta‐analyses (PRISMA) flow diagram of the literature search results.
Figure 2
Figure 2
Risk‐of‐bias graph for mean score of visual analog scale/numeric rating scale for participants' pain/discomfort .
Figure 3
Figure 3
Risk‐of‐bias table for mean score of visual analog scale/numeric rating scale for participants' pain/discomfort.
Figure 4
Figure 4
The mean score of visual analog scale/numeric rating scale for participants' pain/discomfort.
Figure 5
Figure 5
The proportion of participants who checked the highest satisfaction score.
Figure 6
Figure 6
The proportion of participants who showed the best tolerance score.
Figure 7
Figure 7
The proportion of participants who showed the easiest insertion score.
See this image and copyright information in PMC

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