Intravenous lidocaine with propofol‐based sedation for colonoscopy: a systematic review and meta‐analysis with trial sequential analysis

Summary Introduction Intravenous lidocaine is a promising complementary strategy for sedation during surgical procedures. We performed a systematic review and meta‐analysis to compare intravenous lidocaine with placebo as an adjuvant to propofol‐based sedation in patients undergoing colonoscopy. Methods We searched MEDLINE, Embase and Cochrane databases for randomised controlled trials comparing sedation with propofol and lidocaine vs. propofol and placebo in patients undergoing colonoscopy. The primary outcome was total propofol dose. A random‐effects model was used to estimate the mean differences and risk ratios. Results We included eight trials with 520 patients. Compared with placebo, intravenous lidocaine reduced propofol consumption during the procedure (mean difference (95%CI): ‐42.93 mg (‐62.89 to ‐22.97)); shortened awakening time (mean difference (95%CI): ‐3.38 minutes (‐5.92 to ‐0.84)); reduced post‐procedural pain scores (mean difference (95%CI): ‐1.38 (‐2.72 to ‐0.04)); and increased patient satisfaction scores (mean difference (95%CI): 0.50 (0.30 to 0.70)). There were no significant differences between the groups in procedure duration; endoscopist satisfaction scores; and risk of hypoxia or hypotension. Discussion In patients undergoing colonoscopy, the addition of intravenous lidocaine to propofol‐based sedation reduced propofol consumption, shortened awakening time, mitigated post‐procedural pain and enhanced patient satisfaction compared with placebo. Although the findings are statistically significant, clinical relevance and cost‐effectiveness are unclear.