Towards better tolerability in awake endoscopy : A comparison of Lignocaine Lozenges and spray as topical anesthetic

Upper Gastro Intestinal Endoscopy (UGIE) is a critical tool in gastroenterology for screening, diagnosing and treating digestive disorders. Lignocaine has always been used for topical anesthesia, as it efficiently decreases cough reflex, gag reflex and airway hyper-reactivity during instrumentation of oral and pharyngeal cavity. Also, easy availability, cost effectiveness and ease of administration make it a logical choice. This is usually done by administration of a spray, gargle, viscous or nebulized forms that has a bitter taste that is repulsive. Improper dosing and gargling methods might lead to variable dosing and variable levels of anesthesia that might leave a bad experience for the patient and the operator. Additionally, the spray can lead to sore throat, hoarseness of voice and dysphagia. However, upto 40% of patients experience significant discomfort due to a strong gag reflexand a bitter taste of spray, which can hinder scope insertion and maneuvering. Additionally, they can evoke cardiopulmonary complications in the form of arrhythmias, myocardial ischemia, aspiration and hypoxia.To mitigate these issues, UGI Endoscopies are performed with topical pharyngeal anesthesia, with occasional intravenous sedation. Various formulations like viscous solution, gel, inhaler, popsicles and nebulized forms have been used extensively and evaluated for efficacy.

Lignocaine when used as a lozenge is promising but fewer studies have evaluated their efficacy and safety profile to conventional methods. Lignocaine lozenges have been introduced recently and is purported to offer better experience during UGIE. The advantage of a single dose, solid lozenge that is sucked and dissolved in saliva with advantages of multi-directional delivery to oral and pharyngeal mucosa over an extended contact time. It offers easy administration, better taste and compliance, thereby improving drug delivery.

This study aims to investigate Lignocaine lozenges as a superior topical anesthetic for UGIE, by comparing their effectiveness with 10% Lignocaine spray in reducing patients discomfort and facilitating ease of insertion and manipulation during procedures. The data thus collected will address gaps in current practices while evaluating differences in application methods and adverse effects. Establishing Lignocaine lozenges as a viable alternate could enhance patients comfort, improve procedural efficiency and decrease the need for sedation while advancing standard of care in UGIE.