氯胺酮联合利多卡因预防儿童异丙酚注射痛

目的评价和比较单独使用氯胺酮预注射、利多卡因与异丙酚混合注射、氯胺酮与利多卡因联合3种方法减轻异丙酚注射痛的效果。方法选择150例3～10岁择期行外科手术的患儿为实验对象,共分成3组,每组50例。L组接受盐水3 mL,15 s后给予混合有2%利多卡因的异丙酚（容积比1∶19）;K组给予0.4 mg/kg的氯胺酮3 mL,15 s后给予1%异丙酚;KL组给予利多卡因＋氯胺酮。实验由一名不知分组情况的麻醉师依据4分法给注射痛评分。结果 KL组注射痛发生率（8%）显著低于K组（28%,P〈0.05）、L组（32%,P〈0.05）。三组之间异丙酚诱导用量、意识消失时间及并发症（呕吐、喉痉挛、苏醒期躁动、苏醒延迟和注射部位水肿皮疹）方面比较,差异无统计学意义。结论氯胺酮与利多卡因联合可显著降低异丙酚注射痛,完全消除重度疼痛,且不良事件发生率低,诱导平稳。

Lidocaine combined with ketamine preventing propofol injection pain in children

Objective To compare the effects of ketamine pretreatment,propofol mixed with lidocaine and ketamine combined with lidocaine,to determine the best method in preventing the propofol injection pain.Methods 150 children aged 3~10 year old were selected in the study and divided into three groups.Children in group K received 0.4 mg/kg ketamine（3 mL）,1% propofol（after 15 s）.Children in group L received 3 mL saline 15 s before infusion of propofol mixed with lidocaine.Group KL received both ketamine and lidocaine as in group K and group L.The incidence of propofol injection pain was evaluated and compared among groups by an anaesthesia blinded of the grouping.The incidences of complications dose of propofol for induction and time for loss of consciousness were evaluated as well.Results The incidence of propofol injection pain of the combination group was significantly reduced compared to group L（8% vs 32%,P0.05）and group K（8% vs 28%,P0.05）.There was no significant difference in the incidence of complication（such as vomiting,laryngyospasm,emergence agitation,delayed emergence,local edema and rash）,dose of propofol for induction and time for loss of consciousness among the three groups（P0.05）.Conclusion Combination use of ketamine and lidocaine is effective on preventing propofol injection pain,eliminating severe pain completely.The course of induction is smooth with no remarkable adverse event.