Clinical trial NCT01832675: Clinical Trial With Bupivacaine Lozenges as Local Anaesthesia Under Upper Gastrointestinal Endoscopy
Official title: New Bupivacaine Lozenge as Topical Anesthesia Compared to Lidocaine Pharyngeal Spray Before Upper Gastrointestinal Endoscopy in Unsedated Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Application Site Discomfort
Keywords: Endoscopy
Anesthetics, Local
Bupivacaine
Lidocaine
Lead sponsor: Hvidovre University Hospital
Sponsor class: OTHER
Collaborators: name: Oracain II Aps
First posted: 2013-04-16
Enrollment: 100
Sex: ALL
Minimum age (years): 18
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: In this project the investigators want to compare a new anaesthetic method during upper gastroscopic endoscopy, compared to the traditional used method in a private clinic. The new method is a lozenge containing bupivacaine, and the traditional method is a lidocaine spray.

Detailed description: The research group has previously conducted a clinical study with patients who underwent an UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark, where the effect of a new lidocaine lozenge was compared to the lidocaine suspension that was used as standard treatment. The results showed that the lozenge increased the patient's acceptance of the gag reflexes, decreased the patient discomfort during UGE and thereby increased patient acceptance of the UGE. Furthermore, there was a significant improvement in assessment of taste and texture of the lozenge compared to the suspension. A study by Thanvi et al. has shown that it is difficult to obtain valid VAS scores when the patients are sedated, as it might cause amnesia and may impair the patient's ability to make an accurate assessment of the discomfort. Sedation were a limitation for the study conducted by the research group, because of impairment in the patients judgmental abilities. Furthermore a longer duration of the effect of the lozenge was requested. Therefore, the research group reformulated the lozenge and changed the active pharmaceutical ingredient (API) to bupivacaine. Bupivacaine is an amide as lidocaine, but has a longer anesthetic effect and is four times as potent as lidocaine. It would therefore be relevant to optimize the study design and perform a new clinical study with unsedated patients undergoing UGE, where the bupivacaine lozenge was tested.

The clinical study was performed in the private gastrointestinal (GI) clinic at Hvidovre, Denmark. Before the UGE was performed the patient was locally anesthetized in the pharynx with a lidocaine spray as a standard treatment.

The hypothesis was that a bupivacaine lozenge would reduce the patient experienced discomfort during UGE due to a better local anesthetic effect compared to lidocaine spray. Moreover it is hypothesized that the bupivacaine lozenge would be more patient friendly than the lidocaine spray because of a better taste masking according to lesser bitter taste and a pleasant mode of being anesthetized.

The aim of the study was to compare patient discomfort by two different local anesthetic methods. The standard treatment was a lidocaine pharyngeal spray and was compared to the experimental treatment a bupivacaine lozenge. The efficacy and acceptance of the treatments were also examined, as well as the taste of the anesthetics. Furthermore the patient's and endoscopist's assessment of the UGE was examined.

Eligibility criteria: Inclusion Criteria:

* Referral from personal doctor for the upper gastroscopic endoscopy
* Age between 18 and 80 year
* Able to speak, read and understand the danish language
* Must be informed orally and released a written consent and a signed authorization statement

Exclusion Criteria:

* Known allergy to bupivacaine or other local anesthetics of the amide type.
* Pregnancy - the patient will be asked if she uses sufficient contraception. When in doubt a pregnancy test will be performed.
* Breastfeeding
* Use of other medicine before the examination besides the experimental medicine.

Primary outcomes:
measure: The patient experienced discomfort assessed on the Visual Analog Scale
timeFrame: Day 1
Secondary outcomes:
measure: Patient evaluation of taste and texture on a 3 point scale. - The investigator's assessment of the study by answering the questionnaire.
timeFrame: Day 1
measure: Endoscopist evaluation on a 4 point scale.
timeFrame: Day 1
Other outcomes:
Locations:
city: Hvidovre
country: Denmark
facility: Kirurgisk Klinik Hvidovre
Study officials:
affiliation: Kirurgisk Klinik Hvidovre
name: Kaare Nielsen, MD
role: PRINCIPAL_INVESTIGATOR
References: