利多卡因与芬太尼用于预防丙泊酚注射痛的比较性研究
摘要
目的:丙泊酚注射痛的发生率是28%-90%。有许多方法用于降低注射痛的发生。本研究比较了预先静脉注射利多卡因和芬太尼预防丙泊酚注射痛的效果差别。方法:本临床研究采用随机、双盲、对照的方法。将200例行择期无痛人流手术的女性病人(18-40岁,ASAⅠ-Ⅱ)随机分成四个组,每组50例。A组:利多卡因0.5mg/kg,B组:2%利多卡因40mg,C组:芬太尼50μg,D组:生理盐水2ml(对照组)。各试验用药均为2ml,病人于前臂扎止血带后分别经静脉注射上述药物,保持1min后松止血带,开始注射丙泊酚,直到病人意识消失(即:呼之不应,睫毛反射消失)。丙泊酚注射期间使用4分法对病人进行注射痛评分:0=无痛,1=轻度疼痛,2=中等疼痛,3=重度疼痛。术后待病人麻醉清醒,使用视觉模拟评分(VAS)法对注射痛再次评分,VAS评分＞0分判定为有注射痛发生。评价各组疼痛发生率及程度。结果:用4分法评价各组的注射痛发生率分别是A组:19人(38%),B组:25人(50%),C组:32人(64%),D组:40人(80%),统计学分析表明各组与安慰剂组相比有统计学意义。VAS评价各组注射痛发生率分别是16人(32%)、22人(44%)、30人(60%)、37人(74%),统计学分析表明A组、B组与D组(安慰剂组)相比均有统计学意义,且A组:利多卡因0.5mg/kg与C组:芬太尼50μg相比有统计学意义。但C组:芬太尼组与D(安慰剂组)组相比无统计学意义。各组注射痛严重程度比较结果同上。结论:扎止血带后静脉注射利多卡因0.5mg/kg或40mg并保留止血带1分钟,均可降低丙泊酚注射痛的发生率和严重程度。
Objective: Propofol causes pain on IV injection in 28%-90% of patients. A number of techniques have been tried to minimize propofol-induced pain. We compared the efficacy of pretreatment with lidocaine 0.5 mg/kg and 40 mg and fentanyl 50μg after venous occlusion for prevention of propofol-induced pain. Methods: In a randomized, double blinded, placebo-controlled clinical trial, 200 adult female patients,ASA physical status I-II,undergoing elective surgery were randomly assigned into 4 groups of 50 each , Group A received lidocaine 0.5 mg/kg iv , Group B received 2 % lidocaine 40 mg iv, Group C received f entanyl 50μg iv, and Group D received 0.9% saline 2ml iv (placebo group) All pretreatment drugs were made in 2 ml and were accompanied by manual venous occlusion for 1 min, after release of venous occlusion, followed by administration of propofol into a dorsal hand vein until patients lost of consciousness. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol i njection, and re-assessed using visual analogue scale (VAS) system when patients awake from anesthesia. Recall of pain was considered with a visual analogue scale (VAS) score>0, the incidence and severity of pain were evaluated. Results: Using four-point scale system: 40 patients (80%) in the placebo group, 19 patients(38 %)in the lidocaine 0.5 mg/kg group (P < 0.05), 25 patients (50%) in the 40 mg lidocaine group (P <0.05),and 32patients (64%) in the fentanyl 50μg group (P >0.05) complained of pain. Analysis showed a significant difference between group A and group D, group B and group D as well as between group C and group D. Using VAS scores system: 37 patients (74%) in the placebo group, 16 patients(32%) in the lidocaine 0.5 mg/kg group (P < 0.05), 22 patients (44%) in the 40 mg lidocaine group (P <0.05),and 30 patients (60%) in fentanyl 50μg group (P <0.05) recall of pain. The difference in the incidence of pain between the lidocaine group and placebo group was significant, as well as between group A and group C, There was no significant difference between fentanyl 50μg group and placebo group. The differences in the severity of pain between four groups have same results. Conclusion: Pretreatment with Lidocaine 0.5 mg/kg or 40 mg along with venous occlusion for 1 min can reduce the incidence and severity of propofol-induced pain.
Objective: Propofol causes pain on IV injection in 28%-90% of patients. A number of techniques have been tried to minimize propofol-induced pain. We compared the efficacy of pretreatment with lidocaine 0.5 mg/kg and 40 mg and fentanyl 50μg after venous occlusion for prevention of propofol-induced pain. Methods: In a randomized, double blinded, placebo-controlled clinical trial, 200 adult female patients,ASA physical status I-II,undergoing elective surgery were randomly assigned into 4 groups of 50 each , Group A received lidocaine 0.5 mg/kg iv , Group B received 2 % lidocaine 40 mg iv, Group C received f entanyl 50μg iv, and Group D received 0.9% saline 2ml iv (placebo group) All pretreatment drugs were made in 2 ml and were accompanied by manual venous occlusion for 1 min, after release of venous occlusion, followed by administration of propofol into a dorsal hand vein until patients lost of consciousness. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol i njection, and re-assessed using visual analogue scale (VAS) system when patients awake from anesthesia. Recall of pain was considered with a visual analogue scale (VAS) score>0, the incidence and severity of pain were evaluated. Results: Using four-point scale system: 40 patients (80%) in the placebo group, 19 patients(38 %)in the lidocaine 0.5 mg/kg group (P < 0.05), 25 patients (50%) in the 40 mg lidocaine group (P <0.05),and 32patients (64%) in the fentanyl 50μg group (P >0.05) complained of pain. Analysis showed a significant difference between group A and group D, group B and group D as well as between group C and group D. Using VAS scores system: 37 patients (74%) in the placebo group, 16 patients(32%) in the lidocaine 0.5 mg/kg group (P < 0.05), 22 patients (44%) in the 40 mg lidocaine group (P <0.05),and 30 patients (60%) in fentanyl 50μg group (P <0.05) recall of pain. The difference in the incidence of pain between the lidocaine group and placebo group was significant, as well as between group A and group C, There was no significant difference between fentanyl 50μg group and placebo group. The differences in the severity of pain between four groups have same results. Conclusion: Pretreatment with Lidocaine 0.5 mg/kg or 40 mg along with venous occlusion for 1 min can reduce the incidence and severity of propofol-induced pain.
引文
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[5]Ohmizo H,Iwama H,Sugita T.Complement activation by propofol and its effectduring propofol anaesthesia[J].Anaesth Intensive Care 1999,27:623-627
[6]F.Abad-Santos,M.A.Galvez-Mugica,M.A.Santos,et al.Pharmacokinetics andPharmacodynamics of a Single Bolus of Propofol 2%in Healthy Volunteers[J].Clin.Pharmacol,April 1,2003,43(4):397-405
[7]Which Clinical Anesthesia Outcomes Are Both Common and Important to Avoid?The Perspective of a Panel of Expert Anesthesiologists[J].Anesth Analg,1999,88:1085-1091
[8]Tan CH,Onsiong MK.Pain on injection of propofol[J].Anaesthsia,1998,53:468-476
[9]Picard P,Tramer MR.Prevention of pain on injection with propofol:a quantitativesystematic review[J].Anesth Analg,2000,90:963-969
[10]Siddall and Michael J.Cousins.Persistent Pain as a Disease Entity:Implications forClinical Management[J].Anesth.Analg.2004,99:510-520
[11]Jeffrey L.Apfelbaum,Connie Chen,Shilpa S.Mehta,et al.Postoperative PainExperience:Results from a National Survey Suggest Postoperative Pain Continues toBe Undermanaged[J].Anesth.Analg.2003,97:534-540
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[17]Adam S,van Bommel J,Pelka M,et al.Propofol-induced injection pain:comparisonof a modified propofol emulsion to standard propofol with premixed lignocaine[J].Anesth Analg 2004,99:1076-1079
[18]Anesth Analg 2003,96:631.Bachmann-Mennenga B,Ohlmer A,Boedeker RH,et al.Preventing pain during injection of propofol:effects of a new emulsion withlidocaine addition[J].Eur J Anaesthesiol,2006,Jul,7:1-6
[19]Wolf A,Weir P,Segar P,et al,Shield J.Impaired fatty acid oxidation in propofolinfusion syndrome[J].Lancet 2002,357:606-607
[20]Doenicke AW,Roizen MF,Rau J,et al.Pharmacokinetics and pharmacodynamics ofpropofol in a new solvent[J].Anesth Analg 1997,85:1399-1403
[21]Scott RP,Saunders DA,and Norman J.Propofol:clinical strategies for preventingthe pain of injection[J].Anaesthesia 1988,43:492-494
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[23]P.K.Dubey and A.Kumar.Pain on Injection of Lipid-Free Propofol and PropofolEmulsion Containing Medium-Chain Triglyceride:A Comparative Study[J].Anesth.Analg,October 1,2005,101(4):1060-1062
[24]N.C.H.Sun,A.Y.C.Wong,and M.G.Irwin.A Comparison of Pain on IntravenousInjection Between Two Preparations of Propofol[J].Anesth.Analg,September1,2005,101(3):675-678
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