Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
Minerva Anestesiol. 2010 Sep;76(9):720-4. Epub 2010 Jun 28.
The use of propofol often results in pain upon injection. Various strategies can be used to reduce this pain, ranging from the administration of analgesics to modification of the propofol emulsion. However, basic premedication protocol aimed at peri- and postoperative pain reduction could also sufficiently reduce propofol injection pain, rendering other special interventions redundant.
With the approval of the Local Ethics Committee of the Erasmus Medical Centre Rotterdam, and after obtaining written informed consent from each patient included, 209 surgical patients (ASA physical status I-III) were randomized in a double-blind manner to receive premedication consisting of 7.5 mg midazolam, 50 mg diclofenac and 1000 mg acetaminophen (all orally administered) and fentanyl (intravenously administered) or placebo medication the hour before surgery. In both groups a mixture of 40 mL propofol 1% with 2 mL lidocaine 1% was used to induce anesthesia. Pain scores were assessed using a verbal analog scale (VAS) ranging from 0-10.
The premedication group was found to have significantly less pain upon injection of propofol (median VAS 0+/-0-2) (median+/-interquartile range) when compared to the control group (median VAS 1.5+/-0-4; P=0.001). In addition, more patients in the premedication group experienced no pain at all. This effect was still present one hour after extubation.
Even when injection pain is reduced, the use of a premedication regimen clearly has additional value with respect to the patients' experience. Considering the low VAS scores observed overall, it might be worthwhile to reserve additional injection pain-reducing interventions for individual patients rather than adding them as a component of standard practice.
使用丙泊酚常导致注射时疼痛。可采用多种策略来减轻这种疼痛，包括给予镇痛药和改变丙泊酚乳剂。但是，旨在减少围手术期疼痛的基本预处理方案也能充分减轻丙泊酚注射疼痛，使其他特殊干预措施变得多余。
在鹿特丹伊拉斯谟医疗中心地方伦理委员会的批准下，并在每位纳入患者书面知情同意后，209 例手术患者（ASA 身体状况 I-III）被随机分为两组，进行双盲试验，分别接受术前 1 小时给予咪达唑仑 7.5 mg、双氯芬酸 50 mg 和对乙酰氨基酚 1000 mg（均口服）和芬太尼（静脉注射）预处理或安慰剂预处理。在两组中，均使用 40 mL 1%丙泊酚和 2 mL 1%利多卡因混合液诱导麻醉。使用视觉模拟评分（VAS）评估疼痛程度，范围从 0-10。
与对照组（中位数 VAS 1.5+/-0-4；P=0.001）相比，预处理组在注射丙泊酚时疼痛明显减轻（中位数 VAS 0+/-0-2）。此外，更多的预处理组患者完全没有疼痛。这种效果在拔管后 1 小时仍存在。
即使减轻了注射疼痛，预处理方案的使用显然对患者的体验具有额外的价值。考虑到总体观察到的较低 VAS 评分，可能值得为个别患者保留额外的减轻注射疼痛的干预措施，而不是将其添加为标准实践的一部分。
