Kwak Kyung-Hwa, Ha Jaehyun, Kim Youngsoo, Jeon Younghoon
Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Clin Ther. 2008 Jun;30(6):1113-9. doi: 10.1016/j.clinthera.2008.05.019.
Pain on injection is a common adverse effect with propofol used for general anesthesia.
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.
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).
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.
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.
注射痛是丙泊酚用于全身麻醉时常见的不良反应。
本研究旨在评估地塞米松在丙泊酚注射过程中的镇痛效果，并探究地塞米松与利多卡因联合使用是否比单独使用任一药物具有更强的镇痛效果。
在一项双盲前瞻性试验中，计划接受择期整形手术的患者被随机分为四组，分别接受20毫克利多卡因、6毫克地塞米松、20毫克利多卡因与6毫克地塞米松联合用药，或静脉闭塞1分钟的生理盐水，随后将计算出的丙泊酚总剂量的25%（2.5毫克/千克）注入手背静脉。在麻醉诱导前10秒的暂停期间，使用4分语言评分量表（0 = 无，1 = 轻度，2 = 中度，3 = 重度）评估疼痛强度和发生率；1至3分计为疼痛。术后24小时，由一名盲法研究者每小时对患者进行监测，观察注射部位的不良反应（如疼痛、水肿、风团、潮红反应）。
共有140名韩国患者（91名女性，49名男性；平均[标准差]年龄47[14]岁；平均[标准差]身高162[8]厘米；平均[标准差]体重60[8]千克）完成了该研究。各组间人口统计学变量相似。就疼痛强度而言，联合用药组的平均疼痛评分显著低于利多卡因组或地塞米松组（P均<0.01），尽管所有组的疼痛评分中位数均为0。与丙泊酚注射相关的疼痛发生率在联合用药组显著低于利多卡因组或地塞米松组（分别为0%对34.3%和37.1%；P均<0.01）。一名患者（联合用药组）在注射后立即抱怨会阴部瘙痒；然而，数秒内症状缓解，无需任何干预。术后24小时内，未在任何患者的注射部位观察到其他不良反应。
对于这些韩国患者，20毫克利多卡因与6毫克地塞米松联合用药，并静脉闭塞1分钟，在丙泊酚注射期间控制疼痛方面比单独使用20毫克利多卡因或6毫克地塞米松更有效。
