A team from the American University of Beirut Medical Centre (AUBMC) in Lebanon have developed a lollipop containing the local anaesthetic lidocaine.
In a study, published in the October issue of Gastrointestinal Endoscopy , the team found that administering the lidocaine lollipop eliminated the need for sedation in the majority of patients undergoing an upper gastrointestinal endoscopy procedure and was more effective than a lidocaine nasal spray.
Such procedures are often done under sedation to provide patient comfort in order to examine the lining of the upper GI tract.
However, the results of the study found the use of the lollipop eliminated the need for intravenous sedation in nearly two thirds of patients and the use of lower doses of sedatives in the rest.
"A significant portion of the complications, as well as the cost, of upper gastrointestinal endoscopy are often attributed to conscious intravenous sedation," study lead author Assaad Soweid said.
"In this study, we compared the efficacy of topical lidocaine administered in the form of a lollipop as a single-agent anaesthetic with the conventional lidocaine spray, and determined whether it decreased the need for or the amount of intravenous sedation.
We found that 32 per cent of the patients given the lidocaine lollipop required intravenous sedation compared with 96 per cent of the patients who received the spray."
Lidocaine has been on the market for almost 60 years and is available as an injected local anaesthetic, dermal patch, intravenous injection, nasal spray, oral gel and liquid, and formulated as a topical application.
Despite lollipops being used in the past to anaesthetise children, this would be the first time lidocaine would have been formulated in such a way.
"The lollipop proved to be a safe and well-tolerated topical anaesthetic.
It is quite promising and may be particularly important for use with the elderly, patients who have comorbidities and in office-based endoscopy," Soweid said.
The researchers put the effectiveness down to the continuous release of the drug due to the sucking action on the lollipop.
The lollipop used in the study was developed by the anaesthesia department in collaboration with the pharmacy department at AUBMC.
Fifty grams of white sugar was heated until liquefied and an equal amount of golden syrup was slowly added.
For each lollipop, 3ml of this mixture was poured into a small cylindrical container, to which 300mg of lidocaine hydrochloride salt was added.
As the mixture cooled and solidified, a small plastic stick was stuck in.
The researchers speculated that based on the positive results the use of such lollipops would probably lead to lower rates of adverse events requiring interventions and hence lower direct and indirect costs of the procedure.
The researchers also noted the patients would require less recovery time after the procedure.
Fifty patients over the age of 18 participated in the study and were randomly assigned 300mg of lidocaine in either the lollipop or spray form.
In both study groups, the decision to administer intravenous sedation was based on the endoscopist's assessment of patient discomfort, such as excessive gagging, retching, restlessness and combativeness, during the procedure.