Effects of intravenous lidocaine on propofol-based sedation in adult patients during gastrointestinal endoscopic procedures: an updated systematic review and meta-analysis

Introduction: Sedation during endoscopic gastrointestinal procedures is now a routine practise that can improve patient outcomes. Propofol is one of the most commonly used intravenous anaesthetics. However, despite its popularity, it has been associated with various side effects, particularly haemodynamic and respiratory complications, especially in frail patient populations. Intravenous (IV) lidocaine, used as an adjuvant, has already demonstrated its efficacy in improving certain outcomes during sedation with propofol. However, the emergence of further studies requires an update to enhance the quality of existing data and refine this anaesthetic practise. The aim of this systematic review and meta-analysis is to evaluate the efficacy of intravenous lidocaine in reducing propofol consumption, decreasing episodes of desaturation and involuntary movements during the procedure, improving awakening time, relieving post-procedure pain, and increasing endoscopist satisfaction during propofol sedation in gastrointestinal endoscopic procedures (PROSPERO registration: CRD420250651511). Methods: We included randomised controlled trials conducted in adult patients undergoing propofol sedation with IV lidocaine administered as an adjunct during gastrointestinal endoscopic procedures. A comprehensive systematic search was conducted in PubMed/MEDLINE, Scopus and Web of Science from January to February 2025 without language or time restrictions. Risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB2). Results: Seventeen randomised controlled trials (1698 patients) were selected based on full text and included in the study. Lower propofol consumption was observed with intravenous lidocaine compared with the control group (SMD: -1.36, 95 % CI: -1.67 to -1.05; p < 0.001), with consistent results in all subgroups. Awakening time was significantly shorter in the IV lidocaine group (SMD = -0.92 [95 % CI: -1.18 to -0.66]; p < 0.001), while no significant difference was observed in full recovery time. Lidocaine administration was associated with a 59 % reduction in desaturation events, 36 % reduction in hypotension events and a 57 % reduction in involuntary movements. Continuous infusion after bolus administration was required to achieve these effects. Infusion rates of 2 mg/kg/h and 4 mg/kg/h were equally effective. Conclusion: Intravenous lidocaine is a safe and effective adjunct to propofol sedation in gastrointestinal endoscopy, reducing anaesthetic requirements and sedation-related complications. Routine use of lidocaine may increase the safety of the procedure, especially in high-risk populations and complex procedures.