Topical lidocaine inhibits spasm during colonoscopy: a double-blind, randomized controlled trial (with video)

 

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Abstract

Background and study aims Topical peppermint oil prevents intestinal spasm, but can cause rebound spasm. Lidocaine hydrochloride, a local anesthetic, may work as an antispasmodic by blocking Na + channels. The aim of this study was to investigate the effect of topical lidocaine on the inhibition of colonic spasm during colonoscopy, compared with peppermint oil.

Patients and methods A randomized, controlled double-blind trial was conducted in an academic endoscopy unit. Patients requiring endoscopic resection were randomly allocated to colonoscopy with topical administration of lidocaine (n = 30) or peppermint oil (n = 30). Similar vials containing different solutions were randomly numbered. Allocation was made based on the vial number. The solution used and the vial number were not revealed during the study. Two endoscopists performed all procedures using midazolam, without anticholinergic agents. When a pre-selected lesion was identified, the solution in the assigned vial was dispersed and the bowel observed for 5 minutes. The primary endpoint was the duration of spasm inhibition, and a secondary endpoint was the occurrence of rebound spasm stronger than before dispersion.

Results There were no significant differences in patient demographics. Spasm was inhibited in almost all patients in both groups, with a similar median duration (lidocaine 227 sec vs. peppermint 212.5 sec, P = 0.508). In contrast, rebound spasm occurred less frequently in the lidocaine group (lidocaine 7 % vs. peppermint 47 %, P = 0.001). There were no adverse events or symptoms associated with administration of the solutions.

Conclusions The inhibitory effect of lidocaine is not superior to peppermint oil. However, lidocaine significantly decreases the frequency of rebound spasms.

• References

• 1 East JE, Saunders BP, Burling D. et al. Mechanisms of hyoscine butylbromide to improve adenoma detection: A case-control study of surface visualization at simulated colonoscope withdrawal. Endosc Int Open 2015; 3: E636-641
  Article in Thieme ConnectPubMedGoogle Scholar
• 2 Ashraf I, Ashraf S, Siddique S. et al. Hyoscine for polyp detection during colonoscopy: A meta-analysis and systematic review. World J Gastrointest Endosc 2014; 6: 549-554
  CrossrefPubMedGoogle Scholar
• 3 Marshall JB, Patel M, Mahajan RJ. et al. Benefit of intravenous antispasmodic (hyoscyamine sulfate) as premedication for colonoscopy. Gastrointest Endosc 1999; 49: 720-726
  CrossrefPubMedGoogle Scholar
• 4 Mui LM, Ng EK, Chan KC. et al. Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine N-butyl bromide in patients undergoing colonoscopy with patient-controlled sedation. Gastrointest Endosc 2004; 59: 22-27
  CrossrefPubMedGoogle Scholar
• 5 Norfleet RG. Premedication for colonoscopy: randomized, double-blind study of glucagon versus placebo. Gastrointest Endosc 1978; 24: 164-165
  CrossrefPubMedGoogle Scholar
• 6 Umegaki E, Abe S, Tokioka S. et al. Risk management for gastrointestinal endoscopy in elderly patients: questionnaire for patients undergoing gastrointestinal endoscopy. J Clin Biochem Nutr 2010; 46: 73-80
  PubMedGoogle Scholar
• 7 Yoshikawa I, Yamasaki M, Taguchi M. et al. Comparison of glucagon and scopolamine butylbromide as premedication for colonoscopy in unsedated patients. Dis Colon Rectum 2006; 49: 1393-1398
  CrossrefPubMedGoogle Scholar
• 8 Asao T, Mochiki E, Suzuki H. et al. An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm. Gastrointest Endosc 2001; 53: 172-177
  CrossrefPubMedGoogle Scholar
• 9 Hiki N, Kurosaka H, Tatsutomi Y. et al. Peppermint oil reduces gastric spasm during upper endoscopy: a randomized, double-blind, double-dummy controlled trial. Gastrointest Endosc 2003; 57: 475-482
  CrossrefPubMedGoogle Scholar
• 10 Grigoleit HG, Grigoleit P. Gastrointestinal clinical pharmacology of peppermint oil. Phytomedicine 2005; 12: 607-611
  CrossrefPubMedGoogle Scholar
• 11 Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective. Gastrointest Endosc 2002; 56: 672-674
  CrossrefPubMedGoogle Scholar
• 12 Lee H, Kim JJ, Min BH. et al. Effectiveness of warm water consumption to reduce patient discomfort during colonoscopy: a randomized controlled trial. Am J Gastroenterol 2009; 104: 2935-2941
  CrossrefPubMedGoogle Scholar
• 13 Lee BY, Katon R, Herzig D. et al. Warm water infusion during sedated colonoscopy does not decrease amount of sedation medication used. Gastrointest Endosc 2012; 76: 1182-1187
  CrossrefPubMedGoogle Scholar
• 14 Hawthorn M, Ferrante J, Luchowski E. et al. The actions of peppermint oil and menthol on calcium channel dependent processes in intestinal, neuronal and cardiac preparations. Aliment Pharmacol Ther 1988; 2: 101-118
  PubMedGoogle Scholar
• 15 Hills JM, Aaronson PI. The mechanism of action of peppermint oil on gastrointestinal smooth muscle. An analysis using patch clamp electrophysiology and isolated tissue pharmacology in rabbit and guinea pig. Gastroenterology 1991; 101: 55-65
  CrossrefPubMedGoogle Scholar
• 16 Sheets MF, Fozzard HA, Lipkind GM. et al. Sodium channel molecular conformations and antiarrhythmic drug affinity. Trends Cardiovasc Med 2010; 20: 16-21
  CrossrefPubMedGoogle Scholar
• 17 Fozzard HA, Sheets MF, Hanck DA. The sodium channel as a target for local anesthetic drugs. Front Pharmacol 2011; 2: 68
  PubMedGoogle Scholar
• 18 Aronchick CA, Lipshutz WH, Wright SH. et al. Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 1999; 94: 2667
  PubMedGoogle Scholar
• 19 Catterall WA, Mackie K. Local Anesthetics. In: Brunton L, Lazo JS, Parker KL. , editors. Goodman & Gilman's The Pharmocological Basis of Therapeutics. 11th ed. New York: MacGraw-Hill; 2006: 369-386
  Google Scholar
• 20 Amato A, Liotta R, Mule F. Effects of menthol on circular smooth muscle of human colon: analysis of the mechanism of action. Eur J Pharmacol 2014; 740: 295-301
  CrossrefPubMedGoogle Scholar
• 21 Dinning PG, Wiklendt L, Omari T. et al. Neural mechanisms of peristalsis in the isolated rabbit distal colon: a neuromechanical loop hypothesis. Front Neurosci 2014; 8: 75
  PubMedGoogle Scholar