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Background <p>Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation with propofol, which carries a risk of dose-dependent cardio-respiratory complications. Intravenous lidocaine (IVL) has been proposed as an adjuvant to enhance sedative safety and efficiency.</p> Methods <p>Following PRISMA guidelines, a systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for randomized controlled trials (RCTs) comparing IV lidocaine plus propofol versus propofol alone during ERCP. Outcomes included total propofol consumption, recovery time, pain scores, and sedation-related adverse events (hypoxia, hypotension, involuntary movement, and post-ERCP pancreatitis). The risk of bias was assessed using the RoB2 tool, and the certainty of the evidence was evaluated using the GRADE approach. A random-effects meta-analysis was performed using RevMan software.</p> Results <p>Four RCTs comprising 402 patients were included. IV lidocaine significantly reduced total propofol consumption (mean difference = − 72.95&#xa0;mg; 95% CI − 87.09 to − 58.82; <i>P</i> &lt; 0.00001) and shortened recovery time (MD = − 4.43&#xa0;min; 95% CI − 7.09 to − 1.76; <i>P</i> = 0.001). Post-operative pain scores decreased modestly (MD = − 0.79; <i>P</i> = 0.02). Lidocaine reduced the risk of hypoxia (RR = 0.30; <i>P</i> = 0.03), hypotension (RR = 0.41; <i>P</i> = 0.02), and involuntary movement (RR = 0.44; <i>P</i> = 0.003), without affecting post-ERCP pancreatitis incidence. Most trials had a low risk of bias.</p> Conclusions <p>Based on a limited evidence base of four RCTs, intravenous lidocaine reduces propofol requirements and shortens recovery time during ERCP. Signals toward reduced hypoxia and hypotension were observed but were not robust in sensitivity analyses, and several secondary outcomes showed substantial heterogeneity. Larger, adequately powered multicenter RCTs with standardized co-medication and lidocaine dosing protocols are warranted before firm conclusions about safety benefits can be drawn.</p>

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Intravenous Lidocaine as an Adjunct to Propofol Sedation for Endoscopic Retrograde Cholangiopancreatography: A Systematic Review and Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年5月19日

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  • Ahmed Ali Lotfy,
  • Atef A. Hassan,
  • Abeer Shaban Goda,
  • Fatmaelzahraa Omar Mahmoud Bahr,
  • Jehan Mohamed,
  • Doaa Lotfy Abd El Baky

摘要

Background

Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation with propofol, which carries a risk of dose-dependent cardio-respiratory complications. Intravenous lidocaine (IVL) has been proposed as an adjuvant to enhance sedative safety and efficiency.

Methods

Following PRISMA guidelines, a systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was conducted for randomized controlled trials (RCTs) comparing IV lidocaine plus propofol versus propofol alone during ERCP. Outcomes included total propofol consumption, recovery time, pain scores, and sedation-related adverse events (hypoxia, hypotension, involuntary movement, and post-ERCP pancreatitis). The risk of bias was assessed using the RoB2 tool, and the certainty of the evidence was evaluated using the GRADE approach. A random-effects meta-analysis was performed using RevMan software.

Results

Four RCTs comprising 402 patients were included. IV lidocaine significantly reduced total propofol consumption (mean difference = − 72.95 mg; 95% CI − 87.09 to − 58.82; P < 0.00001) and shortened recovery time (MD = − 4.43 min; 95% CI − 7.09 to − 1.76; P = 0.001). Post-operative pain scores decreased modestly (MD = − 0.79; P = 0.02). Lidocaine reduced the risk of hypoxia (RR = 0.30; P = 0.03), hypotension (RR = 0.41; P = 0.02), and involuntary movement (RR = 0.44; P = 0.003), without affecting post-ERCP pancreatitis incidence. Most trials had a low risk of bias.

Conclusions

Based on a limited evidence base of four RCTs, intravenous lidocaine reduces propofol requirements and shortens recovery time during ERCP. Signals toward reduced hypoxia and hypotension were observed but were not robust in sensitivity analyses, and several secondary outcomes showed substantial heterogeneity. Larger, adequately powered multicenter RCTs with standardized co-medication and lidocaine dosing protocols are warranted before firm conclusions about safety benefits can be drawn.