A DOUBLE-BLIND RANDOMIZED TRIAL OF LOW-DOSE VERSUS HIGH-DOSE TOPICAL ANESTHESIA IN UNSEDATED UPPER GASTROINTESTINAL ENDOSCOPY

Background: Upper gastrointestinal endoscopy is frequently performed o n unsedated subjects. Pharyngeal anaesthesia is thought to improve pat ient tolerance to the procedure but the optimum dose of anaesthesia is not known. The aim of this study was to assess the benefits of low-do se vs. high-dose topical anaesthesia in unsedated gastroscopy. Methods : One hundred and fourteen subjects attending for diagnostic gastrosco py were studied. Patients were randomized to receive either 30 mg or 1 00 mg of topical pharyngeal lidocaine spray prior to endoscopy in a do uble-blind fashion. Subjects completed a questionnaire before and afte r endoscopy. Results: A similar proportion of patients in each group r equired intravenous sedation because of discomfort or anxiety during t he procedure (P = 0.48). The high-dose group experienced less discomfo rt during endoscope insertion (P = 0.002) and throughout the examinati on (P = 0.01). Overall satisfaction was almost identical in the two gr oups (P = 0.85) and a similar percentage of the high-dose and low-dose groups stated that they would request sedation prior to future endosc opy (37 vs. 44%; P = 0.48). Further analysis showed that apprehensive patients and younger patients reported relatively high levels of disco mfort, and that female subjects were more likely to express a preferen ce for sedation at any future gastroscopy. Conclusion: High-dose phary ngeal anaesthesia reduces patient discomfort during unsedated upper ga strointestinal endoscopy. However, patient tolerance is also influence d by clinical features, which might be useful in deciding which patien ts are suitable for this procedure.