The Effect of Intravenous Lidocaine on Duodenal Peristalsis and Sedation Quality During Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Trial.

Background/Aims: The current study aimed to evaluate the effects of intravenous (IV) lidocaine on sedative requirements, duodenal peristalsis, and procedural outcomes in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) under deep sedation. Materials and Methods: In this prospective, randomized, double-blind, placebo controlled study, 120 patients with ASA I-III who were scheduled for elective ERCP were enrolled. Participants were randomized to 2 groups: the lidocaine group (n = 60) received a 1 mg/kg bolus followed by a 2 mg/kg/h infusion, whereas the control group (n = 60) received an equivalent volume of 0.9% saline. Sedation was maintained with propofol and titrated to a Bispectral Index of 60-80. Duodenal peristalsis was assessed using a predefined semiquantitative peristalsis scoring system. Results: Demographic characteristics were similar between groups. Total propofol consumption was significantly lower in the lidocaine group (P < .001). Recovery and discharge times were significantly shorter in the lidocaine group than in the control group (P < .001 for both). Clinically adequate inhibition of duodenal peristalsis was observed more frequently in the lidocaine group (90.0% vs. 75.0%; P = .031), and the requirement for rescue antispasmodics was lower (P = .018). Complication rates, cannulation time, primary success rate, and endoscopist satisfaction were similar between groups. Conclusion: IV lidocaine may serve as a supportive anesthetic-sparing adjunct during ERCP, reducing propofol requirements and facilitating shorter recovery times. Although lidocaine was associated with greater inhibition of duodenal peristalsis and reduced use of rescue antispasmodic, major procedural outcomes were comparable between groups; therefore, these findings should be interpreted cautiously.