Yoshikawa T, Wajima Z, Inoue T, Ogura A, Ogawa R
Department of Anaesthesia, Hakujikai Memorial Hospital, Tokyo, Japan.
Can J Anaesth. 2001 Jun;48(6):538-44. doi: 10.1007/BF03016829.
To determine whether epidural lidocaine reduces the severity of propofol injection pain compared with iv lidocaine.
A prospective, randomized double-blind clinical study was conducted in 120 female patients scheduled for elective gynecological laparotomy. A lumbar epidural catheter and an iv catheter placed in the cephalic vein of the non-dominant hand were used in all patients. Patients of the control group (Group C) were given epidural normal saline followed by iv normal saline then iv propofol. Patients of Group E were given epidural 2% lidocaine (0.08 mL.cm(-1)) followed by iv normal saline and then propofol. Patients of Group V were given epidural normal saline followed by iv 2% lidocaine (0.05 mL.kg(-1)) then propofol. Pain was scored as no pain=0, minimal pain=1, moderate pain=2, severe pain=3.
The pain scores, in group E; 1 (0-2) and group V; 2 (0-2), were significantly lower than in group C; 2 (1-3); median (25th-75th percentile) (P <0.001). There was no difference in pain score between groups E and V The plasma lidocaine concentration 15 min after epidural lidocaine was 2.74 +/- 0.54 microg.ml(-1), compared with 1.54 +/- 0.31 microg.mL(-1) at three minutes after iv lidocaine.
Epidural and iv lidocaine equally reduced the severity of propofol injection pain despite higher lidocaine plasma concentrations in epidurally administered lidocaine.
确定与静脉注射利多卡因相比，硬膜外注射利多卡因是否能减轻丙泊酚注射痛的严重程度。
对120例计划行择期妇科剖腹手术的女性患者进行一项前瞻性、随机双盲临床研究。所有患者均置入腰椎硬膜外导管和非优势手头静脉的静脉导管。对照组（C组）患者先接受硬膜外注射生理盐水，然后静脉注射生理盐水，再静脉注射丙泊酚。E组患者先接受硬膜外注射2%利多卡因（0.08 mL·cm⁻¹），然后静脉注射生理盐水，再注射丙泊酚。V组患者先接受硬膜外注射生理盐水，然后静脉注射2%利多卡因（0.05 mL·kg⁻¹），再注射丙泊酚。疼痛评分标准为：无痛=0分，轻微疼痛=1分，中度疼痛=2分，重度疼痛=3分。
E组疼痛评分为1（0 - 2）分，V组为2（0 - 2）分，均显著低于C组的2（1 - 3）分；中位数（第25 - 75百分位数）（P <0.001）。E组和V组的疼痛评分无差异。硬膜外注射利多卡因15分钟后的血浆利多卡因浓度为2.74±0.54μg·mL⁻¹，而静脉注射利多卡因3分钟后的血浆利多卡因浓度为1.54±0.31μg·mL⁻¹。
尽管硬膜外注射利多卡因的血浆利多卡因浓度较高，但硬膜外和静脉注射利多卡因减轻丙泊酚注射痛严重程度的效果相当。
