Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults

Background: Many patients experience pain on injection of propofol. The use of lidocaine to prevent propofol injection pain is common. The analgesic effect of pre-injected lidocaine has been found to increase when a tourniquet is used.Objective: The aim of this study was to compare the effectiveness of various venous occlusion times with lidocaine analgesia to prevent pain during propofol injection.Methods: In this prospective, randomized, double-blind, controlled study, women aged 18 to 45 years, classifed as American Society of Anesthesiologists physical sta- tus I or II, who were scheduled to undergo elective surgery under general anesthesia induced with propofol, were randomly assigned to 1 of 5 groups: group 1, 2% lidocaine 20 mg in saline in a total volume of 10 mL and no venous occlusion; group 2, 2% lidocaine 20 mg in saline in a total volume of 10 mL plus venous occlusion for 15 seconds; group 3, 2% lidocaine plus venous occlusion for 30 seconds; group 4, 2% lidocaine plus venous occlusion for 60 seconds; and group 5, saline 10 mL and no venous occlusion. When the first 25% of the calculated propofol dose was administered, patients were asked about propofol-induced pain using a verbal pain scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). All patients and the anesthesiologist who evaluated pain severity were blinded to the study preparation being used.Results: The study comprised 100 women who were randomly divided into 5 groups of 20 patients each. Significantly more patients in group 5 (18 [90%] patients; P < 0.05) reported pain compared with the other treatment groups. In groups 2, 3, and 4, in which venous occlusion was applied, pain was reported during propofol injection in 6 (30%), 7 (35%), and 2 (10%) patients, respectively. The incidence of reported pain was significantly greater in group 1 (lidocaine without venous occlusion) than in group 4 (P < 0.05); however, the incidence of pain was similar in group 1 compared with groups 2 and 3.Conclusions: The present study found that pretreatment with lidocaine 20 mg with or without venous occlusion significantly reduced the incidence and the severity of pain during the injection of propofol when compared with the group with no venous occlusion administered saline. In addition, pretreatment with lidocaine 20 mg plus venous occlusion for 60 seconds significantly reduced the incidence of propofol-induced pain compared with lidocaine without venous occlusion.     

氟比洛芬酯和利多卡因联用缓解异丙酚注射痛的随机对照研究

目的 探讨联合应用氟比洛芬酯和利多卡因做静脉预处理缓解异丙酚注射痛的效果.方法 将160例拟行择期手术的ASI 1～2级全麻患者随机分为对照组、利多卡因组(Lc组)、氟比洛芬酯组(FA组)和氟比洛芬酯和利多卡因联用组(联用组),每组各40例.所有患者在给药前均先以橡胶止血带阻断其局部静脉回流,随后分别给予对照组0.9％ NS7 mL,FA组氟比洛芬酯注射液5mL(50 mg)+0.9％ NS 2 mL,Lc组2％利多卡因2mL(40 mg)+0.9％ NS 5 mL,联用组氟比洛芬酯注射液5mL (50 mg) +2％利多卡因2mL (40 mg);2 min后撤止血带,在5s内给入0.5 mg/kg的异丙酚.给药同时由另一位麻醉师以相同的方式及问题询问患者注射部位情况,采用VRS评分.结果 4组间一般情况比较无明显差异.Lc组、FA组、联用组的异丙酚注射痛发生率明显低于对照组(P＜0.05),联用组疼痛发生率低于其余3组.在注射痛强度评分方面,Lc组和联用组的疼痛强度明显低于对照组.术后24 h随访,患者注射部位无红肿、静脉炎或药疹等不良反应情况,亦无预期的胃肠刺激症状.结论 氟比洛芬酯和利多卡因联用做静脉预处理可有效缓解异丙酚注射痛,且不会增加不良反应.     

Comparison of effect of premixed lidocaine in propofol with or without ketorolac pretreatment with placebo on reducing pain on injection of propofol: A prospective, randomized, double-blind, placebo-controlled study in adult Korean surgical patients

Background: Pain on injection of propofol is a common adverse event.Objective: The aim of this study was to investigate the effect of a combination of ketorolac pretreatment and premixed lidocaine in propofol compared with placebo on propofol injection pain.Methods: In this prospective, randomized, double-blind, placebo-controlled study, Korean patients scheduled for elective plastic surgery were randomized to 1 of 3 groups. Group A received 15 mg ketorolac in saline IV as pretreatment. Groups B and C received 3 mL saline IV as pretreatment. Sixty seconds after pretreatment, groups A and B received a mixture of lidocaine 1% in propofol 1% at a 1:10 ratio and group C received propofol 1% alone. Pain during propofol injection was assessed on a 4-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe).Results: Ninety patients (41 men, 49 vvomen; mean age, 41.7 years; mean weight, 63 kg) completed the study. The overall incidence of pain on propofol injection was significantly lower in groups A (16.7%) and B (36.7%) than in group C (83.3%; both, P < 0.001). There was no significant difference in the incidence of pain between groups A and B. However, the patients in group A reported a significantly lower incidence of moderate (0% vs 33.3%; P < 0.001) and severe pain (0% vs 20%; P = 0.024) compared with those in group C. There were no significant differences in the incidences of moderate and severe pain between the B and C groups.Conclusions: In this Korean population, premixed lidocaine in propofol with or without ketorolac pretreatment was associated with significantly less pain when compared with placebo. The combination of ketorolac pretreatment and premixed lidocaine in propofol was more effective in decreasing the incidence of moderate or severe pain compared with placebo.     

氯诺昔康对异丙酚静脉注射痛的预防作用

目的：与利多卡因和安慰剂对照比较，观察氯诺昔康对异丙酚静脉注射引起的疼痛缓解程度。方法：选择120例ASAⅠ～Ⅱ级的择期手术病人，随机分为4组：Ⅰ组在施行异丙酚诱导之前60s,给予氯诺昔康4mg(2m1)；Ⅱ组在施行异丙酚诱导之前60s给予氯诺昔康8mg(2m1)；Ⅲ组在施行异丙酚诱导之前60s给予利多卡因40mg(2m1)；Ⅳ组在施行异丙酚诱导之前60s给予生理盐水(2m1)。观察每组疼痛的发生率和根据Ambesh法进行疼痛评分。结果：与安慰剂对照组相比，氯诺昔康和利多卡因一样可以降低异丙酚静脉注射疼痛发生率，不同剂量的氯诺昔康与降低疼痛程度无显著差异，氯诺昔康与利多卡因之间也无显著差异。结论：氯诺昔康作为麻醉的辅助用药，可降低异丙酚引起的静脉注射痛，与利多卡因比较无明显差异，而氯诺昔康4mg与8mg剂量疼痛缓解率相同。     

氟比洛芬酯用于防治丙泊酚注射痛的临床观察

目的观察氟比洛芬酯防治丙泊酚注射痛的疗效。方法将100例ASAⅠ-Ⅱ级择期手术患者随机分成4组,每组25例。各组患者于注射丙泊酚前均在前臂用止血带人为阻断血流2min后分别静推利多卡因40mg（A组）、甲氧氯普胺10mg（B组）、氟比洛芬酯50mg（C组）、生理盐水5mL（D组）,注射完毕1min后松开止血带,静推丙泊酚注射液行麻醉诱导,观察每组疼痛发生率,并根据Ambesh法评分。结果A、B、C组的注射痛发生率和疼痛程度明显低于D组,差异有统计学意义（P〈0．01）。结论氟比洛芬酯能有效降低丙泊酚注射痛的发生率并减轻疼痛程度,与利多卡因、甲氧氯普胺的疗效相当。     

Reducing the Pain of Microemulsion Propofol Injections: A Double-Blind,Randomized Study of Three Methods of Tourniquet and Lidocaine

Background

Although the new formulation of lipid-free microemulsion propofol (MP) has some advantages over the lipid emulsion, it reportedly produces more injection pain than lipid-based propofol. Intravenous lidocaine with application of a rubber tourniquet before administration of propofol is considered to be the best method for reducing injection pain; however, this technique is not perfect.

Objective

The goal of this study was to evaluate the effect of different methods of tourniquet application and lidocaine administration on MP injection pain.

Methods

This single-center, randomized controlled clinical trial was conducted in 140 patients aged 18 to 65 years. Patients were randomly divided into 4 groups (n = 35 each). Group A received MP (2 mg/kg) after lidocaine (0.6 mg/kg) with a tourniquet with arm down (venous engorgement); group B received MP after lidocaine with a tourniquet with arm up (venous gravity drainage); group C received MP with a tourniquet with arm down; and group D (control group) received MP only (with no tourniquet). In groups A and C, the tourniquet was released after MP; in group B, the tourniquet was released before MP. Injection pain was evaluated by using a verbal pain score (VPS). The bispectral index, the time from the beginning of drug injection to the loss of eyelash reflex, and time to the lowest bispectral index value were recorded.

Results

Group A showed significantly less incidence of pain than the control group when MP was injected. The mean VPS was significantly lower in groups A, B, and C than in group D (the control group). The VPS of group A was significantly lower than that in group B. Other observed values were not significantly different.

Conclusions

We concluded that intravenous retention of lidocaine with the application of a rubber tourniquet under venous engorgement of the arm reduces the incidence and intensity of MP injection pain. Clinical trial registry: UMIN000010725.     

托烷司琼复合利多卡因预防丙泊酚注射痛的疗效观察

目的观察托烷司琼复合利多卡因预防丙泊酚注射痛的效果。方法采取随机双盲法将符合标准择期拟行手术的200例患者分为4组,I组（n=50）：生理盐水2mL;II组（n=50）：2％利多卡因40mg;Ⅲ组（n=50）：托烷司琼5mg;IV组（n=50）：托烷司琼5mg与2％利多卡因40mg。四组从静脉注射上述药物lmin后,以0．5mL／s的速度按2mg／kg脉注射丙泊酚进行诱导。根据Ambesh四分法观察每组疼痛的发生率及程度。结果Ⅱ、Ⅲ、Ⅳ实验组与对照组I组比较均可以明显降低丙泊酚静脉注射疼痛的发生率及严重程度（P〈0．05）,而Ⅱ、Ⅲ实验组间差异无统计学意义（P〉0．05）,Ⅱ组与Ⅳ组间（P〈0．05）及组与Ⅳ组间（P〈0．05）差异有统计学意义。结论在丙泊酚静脉注射前缓慢预注托烷司琼复合利多卡因能有效预防丙泊酚注射痛的发生率及严重程度。     

混合预注舒芬太尼及利多卡因在无痛胃镜检查中缓解丙泊酚注射痛的临床观察

【目的】观察预给舒芬太尼和（或）利多卡因预防无痛胃镜检查中丙泊酚注射痛的效果。【方法】采用双盲法,选择行无痛胃镜检查的患者200例,随机分为舒芬太尼组（S组）、利多卡因组（L组）、舒芬太尼联合利多卡因组（SL组）及生理盐水组（C组）,每组50例。给予丙泊酚前1min,四组患者分别静脉注射舒芬太尼（0．2μg／kg,2mL）、利多卡因40mg（2mL）、舒芬太尼＋利多卡因（0．2μg／kg＋40mg）以及生理盐水（2mL）。所有患者以0．5mL／s速度缓慢静脉注射丙泊酚100mg,从预给药开始由另外一名麻醉医生观察是否发生注射痛及严重程度。【结果】与C组比较,L组、S组及SL组注射痛发生率和严重程度均明显降低（P〈0．05）,与S组及L组比较,SL组注射痛发生率及严重程度明显降低（P〈0．05）。【结论】预给舒芬太尼或利多卡因均可有效减少丙泊酚注射痛的发生率以及减轻丙泊酚注射痛的严重程度,且联合舒芬太尼及利多卡因效果更佳。     

伍用利用卡因减少异丙酚注射痛

目的：观察伍用不同剂量的利用卡因对异丙酚注射痛的影响。方法：２００例女性患者ＡＳＡⅠ～Ⅱ级,随机分为４组,每组５０例,采用双盲法分别静注１ｍｌ０．９％盐水、０．５％利多卡因（５ｍｇ）、１％利多卡因（１０ｍｇ）、２％利多卡因（２０ｍｇ）与１９ｍｌ１％异丙酚混合液,观察各组异丙酚注射痛的发生情况。结果：利多卡因明显减小了异丙酚静注即刻和麻醉苏醒后回忆的疼痛发生率及严重程度。利多卡因剂量与异丙酚静注疼痛的发生率及严重程度呈负相关（二者均Ｐ〈０．００１）。结论：伍用利多卡因２０ｍｇ明显减少异丙酚注射痛的发生率及严重程度。     

Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients

Background: The incidence of pain due to propofol injection is high, but the most efficacious method of preventing this pain has not been identified.Objective: The aim of this study was to investigate the efficacy of lidocaine, at different doses and schedules, on propofol injection pain.Methods: In this open-label study, conducted at the Department of Anaesthesiology, Erciyes University Gevher Nesibe Hospital (Kayseri, Turkey), patients with American Society of Anesthesiologists Patient Acuity Classification I-II (ASA I-II) (ie, patients with absent [I] or mild [II] underlying systemic disease) aged 18 to 60 years undergoing various types of surgery were eligible. Patients were randomized to 1 of 4 treatment groups: group 1 received propofol; group 2, a combination of propofol plus lidocaine 10 mg; group 3, lidocaine 10 mg 30 seconds before propofol administration; and group 4, lidocaine 1 mg/kg 30 seconds before propofol administration (all drugs were administered intravenously). After cessation of the standard replacement fluid infusion (isotonic saline), propofol was given at a rate of 2 mL every 5 seconds until a dose of 2 mg/kg was reached. The patients were asked to rate their pain according to the following scale: 0 = none, 1 = mild, 2 = moderate, and 3 = severe.Results: A total of 120 patients (61 men, 59 women; mean [SD] age, 38.7 [8.9] years) were enrolled in the study (n = 30 patients in each group). The incidence of injection pain in groups 2 and 4 was significantly lower than that in groups 1 and 3 (all P<0.05), but no significant difference in the incidence of pain was found between groups 1 and 3. The incidence of pain in group 2 was significantly lower than that in group 4 (P<0.05).Conclusions: In this study population, the addition of 10 mg of lidocaine to propofol 2 mg/kg, or the administration of 1 mg/kg of lidocaine 30 seconds before the administration of propofol 2 mg/kg, effectively decreased pain caused by propofol injection. Furthermore, a lower dose of lidocaine could be used. Based on our results, we suggest mixing propofol with 10 mg of lidocaine to decrease pain due to propofol injection during anesthesia induction.     

不同剂量利多卡因预处理对罗库溴铵注射痛的影响

目的比较利多卡因不同剂量预处理对罗库溴铵注射痛的影响。方法 120例行全身麻醉择期手术的患者按照完全随机的方法分为利多卡因10mg3mL预处理组（A组）,利多卡因25mg3mL预处理组（B组）,利多卡因50mg3mL预处理组（C组）,生理盐水3mL预处理组（D组）。观察不同剂量的利多卡因预处理对罗库溴铵注射痛的影响。结果 A、B、C和D组注射罗库溴铵的疼痛发生率分别为53%、27%、3%和90%。与生理盐水预处理组相比,利多卡因预处理组能明显减轻罗库溴铵引起的注射痛（P〈0.01）;剂量越大,效果越明显。结论利多卡因10、25、50mg预处理均能显著降低罗库溴铵注射时引起的疼痛,以50mg利多卡因更为有效。     

Comparison of lidocaine, metoclopramide, and flurbiprofen axetil for reducing pain on injection of propofol in Japanese adult surgical patients: a prospective, randomized, double-blind, parallel-group, placebo-controlled study

Background: Pain on injection is a recognized adverse event (AE) of propofol administration for the induction of general anesthesia. Pretreatment with lidocaine, metoclopramide, or flurbiprofen axetil has been reported to be effective in reducing propofol-induced pain. However, no studies comparing the efficacy of these 3 drugs for preventing pain on injection of propofol have been identified. Objective: The aim of this study was to compare the efficacy of lidocaine, metoclopramide, and flurbiprofen axetil for reducing pain on injection of propofol in Japanese adult surgical patients. Methods: This prospective, randomized, double-blind, parallel-group, placebo-controlled study was conducted at the Department of Anesthesiology, Ushiku Aiwa General Hospital, Ibaraki, Japan. Japanese patients scheduled to undergo elective surgery were eligible for inclusion in the study. Patients were randomized into 4 groups to receive IV lidocaine 40 mg, metoclopramide 10 mg, flurbiprofen axetil 50 mg, or placebo (saline), preceded by venous occlusion with a rubber tourniquet for 2 minutes, and followed by the administration of propofol 0.5 mg/kg into the largest vein of the hand through a 20-gauge IV cannula. Immediately after the administration of propofol, an investigator blinded to treatment interviewed each patient on injection-site pain. Responses were scored on a 4-point verbal rating scale (0 = none, 1 = mild pain, 2 = moderate pain, and 3 = severe pain). Incidence and intensity of pain (as assessed by mean pain scores) were determined in each of the 4 study groups. AEs at the injection site (eg, pain, edema, wheal, inflammation), extrapyramidal disturbance, and symptoms or signs associated with gastrointestinal (GI) ulceration were assessed by the study investigator for 24 hours following surgery using spontaneous reporting and patient interview. Results: A total of 100 patients (54 women, 46 men) aged 22 to 65 years were enrolled in the study. The patients' mean (SD) age was 42 (12) years. Their mean (SD) height was 161 (8) cm and their mean (SD) weight was 59 (9) kg. Each treatment group comprised 25 patients. There were no significant differences in demographic characteristics between treatment groups. The overall incidence of propofol-induced pain was 24% (6/25 patients) with lidocaine (P = 0.001), 28% (7/25 patients) with metoclopramide (P = 0.001), and 36% (9/25 patients) with flurbiprofen axetil (P = 0.001), compared with placebo (92%, [23/25 patients]). The median pain score was less in patients who had received lidocaine (0), metoclopramide (0), or flurbiprofen axetil (0) than in those who received placebo (2) (all, P = 0.001). The incidence and severity of such pain were not significantly different between the lidocaine-, metoclopramide-, and flurbiprofen axetil-treated groups. There were no reported injection-site AEs, extrapyramidal disturbance, or symptoms or signs associated with GI ulceration observed. Conclusions: In this study of Japanese adult surgical patients, lidocaine 40 mg, metoclopramide 10 mg, and flurbiprofen axetil 50 mg, preceded by venous occlusion for 2 minutes, were effective in reducing pain during the injection of propofol. The analgesic efficacy of these 3 drugs was comparable for minimizing such pain.     

Efficacy of combination intravenous lidocaine and dexamethasone on propofol injection pain: a randomized, double-blind, prospective study in adult Korean surgical patients

BACKGROUND: Pain on injection is a common adverse effect with propofol used for general anesthesia. OBJECTIVES: The aims of this study were to evaluate the analgesic effect of dexamethasone during propofol injection and investigate whether a combination of dexamethasone and lidocaine produced additional analgesic efficacy compared with either treatment alone. METHODS: In a double-blind, prospective trial, patients scheduled to undergo elective plastic surgery were randomized to receive lidocaine 20 mg, dexamethasone 6 mg, combination lidocaine 20 mg and dexamethasone 6 mg, or normal saline with venous occlusion for 1 minute, followed by administration of 25% of the total calculated dose of propofol (2.5 mg/kg) into a dorsal hand vein. Pain intensity and incidence were evaluated during a 10-second pause before the induction of anesthesia, using a 4-point verbal rating scale (0=none, 1=mild, 2=moderate, 3=severe); a score of 1 to 3 was counted as pain. Patients were monitored hourly for 24 hours postsurgery by a blinded investigator for adverse effects at the injection site (eg, pain, edema, wheal, flare response). RESULTS: A total of 140 (35 per group) Korean patients (91 women, 49 men; mean [SD] age, 47 [14] years; mean [SD] height, 162 [8] cm; and mean [SD] body weight, 60 [8] kg) completed the study. Demographic variables were similar among groups. With respect to pain intensity, mean pain score was significantly less in the combination group than in the lidocaine or dexamethasone groups (P<0.01, respectively), although the median pain scores for all groups were 0. The incidence of pain associated with propofol injection was reduced significantly in the combination group compared with the lidocaine or dexamethasone group (0% vs 34.3% and 37.1%, respectively; both, P<0.01). One patient (in the combination group) complained of perineal itching immediately following injection; however, this subsided within a few seconds and did not require any intervention. No other adverse effects at the injection site were observed in any patient in the 24 hours post surgery. CONCLUSION: Combination lidocaine 20 mg and dexamethasone 6 mg, with venous occlusion for 1 minute, was more effective than lidocaine 20 mg or dexamethasone 6 mg alone for pain control during propofol injection in these Korean patients.     

预注射利多卡因与局部加温缓解罗库溴铵注射痛的比较

目的比较预注射利多卡因和局部加温缓解罗库溴铵注射痛效果。方法选取2011年3月-8月择期行腹腔镜下胆囊切除术的150例患者,按照完全随机的方法分为利多卡因组(L组)、局部加温组(W组)、对照组(C组),每组各50例患者。W组患者在留置针部位用Bair Hugger以40°C加温1 min;L组患者用橡胶止血带在静脉近端加压直至静脉输液停止走行,推注1%利多卡因2 mL,1 min后松开止血带。随后3组患者均在2 s内静脉推注1 mL罗库溴铵注射液(含罗库溴铵10 mg)。观察在注射罗库溴铵前预先注射利多卡因及局部加温缓解注射痛的效果。结果罗库溴铵注射痛的发生率在W组、L组、C组中分别为62%、34%、82%。C组的疼痛发生率最高(P<0.05);W组的疼痛率高于L组(P<0.05);与W、L组相比,C组的重度疼痛率最高(P<0.05);L组的中、重度疼痛率低于W组(P<0.05)。结论预注射利多卡因和局部加温均能有效缓解罗库溴铵引起的注射痛,预注射利多卡因对于缓解罗库溴铵引起的注射痛更为有效。     

艾司洛尔预处理对丙泊酚注射痛的影响

目的：观察小剂量艾司洛尔预处理对丙泊酚静脉注射痛的影响。方法：美国麻醉医师协会（ASA）分级为Ⅰ～Ⅱ级且择期行全麻手术的患者120例,随机分为3组,每组40例。经左前臂桡侧浅静脉置入20G套管留置针。麻醉诱导前左上臂包裹气压止血带,加压至70mmHg后,按分组以3mL/10s速度分别静脉注射：0.9%氯化钠液3mL（C组）,利多卡因0.5mg/kg（L组）,艾司洛尔0.25mg/kg（E组）,60s后松开止血带,将2mg/kg丙泊酚在20s内缓慢注入。随后静脉注射芬太尼、维库溴胺,行气管插管全麻。采用4分制记录3组患者丙泊酚注射痛评分,并记录药物预注前（T0）、气管插管前（T1）、气管插管后1min（T2）、气管插管后3min（T3）的平均动脉压（MAP）和心率（HR）。结果：注射痛的发生率C组为65%（26/40）,而L组为10%（4/40）,E组为25%（10/40）,与C组相比显著降低（P〈0.01）。L组和E组中度和重度疼痛的发生率均显著低于C组（P〈0.05和P〈0.01）。E组与L组比较,差异无统计学意义（P〉0.05）。结论：小剂量艾司洛尔预处理合用止血带可有效缓解丙泊酚注射痛。     

Prevention of pain due to injection of propofol with IV administration of lidocaine 40 mg + metoclopramide 2.5, 5, or 10 mg or saline: a randomized, double-blind study in Japanese adult surgical patients

BACKGROUND: Pain on injection is a recognized adverse event (AE) with propofol, an agent used to induce general anesthesia in surgical patients. Lidocame (LID) has been found efficacious in reducing pain on injection of propofol; however, this type of pain may not be completely eliminated with LID. Metoclopramide (MET) is a dopamine receptor agonist with antiemetic and prokinetic properties used for the treatment of nausea and facilitation of gastric emptying in patients with gastroparesis. MET also has local anesthetic properties similar to those of LID. OBJECTIVE: The aim of this study was to examine the effects of LID administered with 3 different doses of MET or saline on pain on injection of propofol in Japanese adults undergoing elective surgery. METHODS: This randomized, double-blind study was conducted at the Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, Tsukuba, Japan. Japanese patients aged 20 to 67 years who were scheduled to undergo elective surgery were eligible for participation. Patients were randomized to receive N administration of LID 40 mg + MET 2.5, 5, or 10 mg or saline. A rubber tourniquet was used to perform 1 minute of venous occlusion before administration of the study and control drugs, and then 25% of the total calculated dose of propofol (2 mg/kg) was injected into the dorsal vein of the hand through a 20-G N cannula at a rate of 1 mL/s. During a 10-second pause before the induction of anesthesia, patients were questioned by a blinded investigator about the pain intensity on injection. Pain intensity was assessed through the use of a 4-point verbal rating scale, with scores ranging from 0 (no pain) to 3 (severe pain). Incidence and intensity of pain (as assessed by mean pain scores) were determined in each of the 4 study groups. Extrapyramidal reactions and injection-site AEs, including pain, edema, wheals, and inflammation occurring up to 24 hours after surgery were recorded by a blinded investigator. RESULTS: The study enrolled 240 patients (126 men, 114 women; mean [SD] age, 43 [13] years [range, 20-67 years]; mean [SD] height, 160 [8] cm [133-181 cm]; mean [SD] body weight, 57 [10] kg [range, 33-85 kg]). There were 60 patients randomized to each of the 4 study groups, which were comparable in distribution of demographic characteristics. Incidence of propofol-induced pain was significantly lower, but the intensity of pain was not less, in the groups that received LID/MET 40/5 or 40/10 (both, 5%) compared with those who received LID/MET 40/2.5 or LID/saline (18% and 20%, respectively) (all, P < 0.05). There were no reports of injection-site AEs or extrapyramidal reactions after injection of the control or study drugs in any of the study groups. CONCLUSION: Among these 240 Japanese patients undergoing elective surgery, N administration of LID/MET 40/5 or 40/10 was associated with lower incidence, but not lower mean pain intensity scores, of pain on injection of propofol than LID/MET 40/2.5 or LID/saline before induction of anesthesia.     

Influence of age on flurbiprofen axetil requirements for preventing pain on injection of propofol in Japanese adult surgical patients: a prospective, randomized, double-blind, vehicle-controlled, parallel-group, dose-ranging study

BACKGROUND: Pain on injection is a recognized adverse event (AE) of propofol administration for the induction of general anesthesia. Preceded by venous occlusion, flurbiprofen axetil, a prodrug of the NSAID flurbiprofen, has been associated with a reduction in pain induced by propofol injection. A review of the literature determined that no published data were available on the influence of age on the requirements for flurbiprofen axetil dose. OBJECTIVE: This study was undertaken to examine the influence of age on flurbiprofen axetil requirements for the treatment of propofol-induced pain on injection in Japanese adult surgical patients. METHODS: This prospective, randomized, double-blind, vehicle-controlled, parallel-group, dose-ranging study was conducted at the Department of Anesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan. Young (age 20-40 years) and older (age 60-80 years) Japanese patients scheduled for various types of surgery (eg, cholecystectomy) were eligible. Patients were randomized to receive flurbiprofen axetil at 1 of 2 doses (25 or 50 mg, regardless of body weight) or inactive vehicle (saline), preceded by manual venous occlusion with a rubber tourniquet for 2 minutes and followed by the infusion of the first 25% of calculated propofol dose (0.5 mg/kg at room temperature, 23 degrees C) into the largest dorsal vein of the hand through a 20-G IV cannula (without local anesthesia), followed by the release of the occlusion and delivery of propofol 2 mg/kg. An investigator blinded to treatment questioned each patient about pain intensity during propofol injection which was assessed using a verbal rating scale: 0 = none; 1 = mild; 2 = moderate; and 3 = severe. The overall prevalence of pain was calculated in each group. AEs at the injection site (pain, edema, wheal, inflammation) were assessed by the study investigator for 24 hours after surgery using spontaneous reporting and patient interview. RESULTS: A total of 150 patients, 75 young adults (38 men, 37 women; mean [SD] age, 31 [5] years; mean [SD] height, 163 [7] cm; mean [SD] body weight, 58 [9] kg) and 75 older adults (38 men, 37 women; mean [SD] age, 70 [6] years; mean [SD] height, 154 [8] cm; mean [SD] body weight, 53 [10] kg), were enrolled. Each treatment group comprised 25 patients. No differences in demographic characteristics were observed among the 3 study groups. In young patients, the overall prevalence of propofol-induced pain was significantly lower in patients who received flurbiprofen axetil 50 mg (12 [48%]) compared with that in patients who received flurbiprofen axetil 25 mg (20 [80%]) or vehicle (22 [88%]) (P < 0.05 and P < 0.01, respectively). The median pain intensity score was significantly lower in patients who received flurbiprofen axetil 50 mg (0) compared with that in patients who received flurbiprofen axetil 25 mg (1) or vehicle (2) (P < 0.05 and P < 0.01, respectively). In older patients, the overall prevalences of pain on propofol injection were 9 (36%) in the flurbiprofen axetil 50-mg group and 11 (44%) in the flurbiprofen axetil 25-mg group compared with 21 (84%) in the vehicle group (both, P < 0.01). The median pain score was significantly lower in patients who received flurbiprofen 50 mg (0) or 25 mg (0) than in those who received vehicle (1) (both, P < 0.01). All treatments were well tolerated. CONCLUSIONS: In this small clinical trial in Japanese surgical patients undergoing general anesthesia, flurbiprofen axetil requirements for the reduction of pain during injection of propofol were found to be 50 mg in young adults (age 20-40 years) and 25 or 50 mg in older adults (age 60-80 years), regardless of weight, preceded by venous occlusion for 2 minutes.     

预先注射美蓝缓解丙泊酚注射部位疼痛的效果

目的探讨麻醉诱导前预先注射美蓝以缓解注射丙泊酚所致注射部位疼痛的效果。方法 2011年4-8月,方便抽样法抽取绍兴市人民医院行下肢骨科手术的患者120例,按随机数字表法将其分为A、B、C 3组各40例,在麻醉诱导静脉注射丙泊酚前1min,3组患者分别预先注射美蓝25、50mg及生理盐水3ml,评价3组患者注射部位疼痛的程度。结果 B组患者重度疼痛例数明显少于A组(P<0.05),A组和B组发生疼痛的例数均少于C组(均P<0.05);A、B组患者丙泊酚注射部位疼痛的发生率分别为47.5%和40.0%,与C组(90.0%)比较,差异有统计学意义(P<0.05或P<0.01);术后24h随访,患者尿液均未出现蓝色。结论预先静脉注射美蓝能有效缓解麻醉诱导注射丙泊酚所致注射部位疼痛,其中预先注射美蓝50mg缓解注射部位疼痛的效果更好。     

Intraurethral tramadol alleviates rigid cystoscopy‐related pain in men

Considering the effectiveness of tramadol in alleviating pain following major operations, trauma, labour and even chronic neuropathic pain, this study was designed to evaluate the efficacy of intraurethral administration of the drug in alleviating cystoscopy‐related pain in men. Sixty male candidates of diagnostic cystoscopy, aged between 20 and 50 years, in ASA physical status I or II were included in the study. Patients were randomized into intervention [who received tramadol (100 mg) and lidocaine gel] or control group (in whom distilled water and lidocaine was administered) based on a permuted block randomization method. The severity of pain and the incidence of adverse effects were measured during and following the cystoscopy. The urologist' satisfaction was also assessed. Total pain score in the intervention group was significantly lower than the control group (P = 0·037). The urologist was more satisfied with the ease and convenience of performing the cystoscopy in the intervention group. No significant side effect was reported in either group. Adding 100 mg tramadol to lidocaine gel is more effective than using lidocaine gel alone in alleviating the pain associating with male rigid cystoscopy.     

芬太尼和舒芬太尼压脉带法预处理用于预防异丙酚注射痛的对比研究

[目的]对比研究芬太尼和舒芬太尼预处理预防异丙酚静脉注射痛（PIP）的临床疗效.[方法]200例ASAⅠ~Ⅱ级接受全麻的择期手术患者,被随机分成四组,每组50例,各组患者注射异丙酚前在前臂结扎一压脉带人为阻断血流,分别予以不同试验药物.F组：芬太尼150 μg;S组：舒芬太尼15 μg;L组：利多卡因40 mg;P组：生理盐水3 mL.注射完毕1 min后松开止血带,再注射1%异丙酚2 mg/kg,注射速度为0.5 mL/s.比较四组PIP情况、麻醉前（T0）、预注药后（T1）和注异丙酚后（T2）的血流动力学指标、呼吸参数及预注试验药物的不良反应.[结果]F组、S组及L组的PIP发生率分别为50%、36%、22%,均显著低于P组80%,其差异有统计学意义（P〈0.01）.四组T1时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）与T0时比较差异无统计学意义（P〉0.05）.四组T2时MAP较T0、T1显著降低（P〈0.01）;HR较T0、T1稍有降低,但差异无统计学意义（P〉0.05）;SpO2较T0、T1均显著降低,其差异有统计学意义（P〈0.05）.四组副反应咳嗽和皮肤瘙痒发生率比较无显著性差异（P〉0.05）.[结论]芬太尼、舒芬太尼预处理均能显著降低PIP的发生率和严重程度;舒芬太尼在预防PIP方面,其外周镇痛作用优于芬太尼.