Goktug Asutay, Gulec Handan, Takmaz Suna Akin, Turkyilmaz Esra, Basar Hulya
Department of Anaesthesiology, Ankara Education and Research Hospital, Ankara, Turkey.
Department of Anaesthesiology, Kecioren Education and Research Hospital, Ankara, Turkey.
Braz J Anesthesiol. 2015 Sep-Oct;65(5):338-42. doi: 10.1016/j.bjane.2014.01.006. Epub 2014 Feb 13.
Injection pain after propofol administration is common and may disturb patients' comfort. The aim of this study was to compare effectiveness of intravenous (iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand or antecubital vein on eliminating propofol injection pain.
There were 147 patients and they were grouped according to the analgesic administered. Metoprolol (n=31, Group M), lidocaine (n=32, Group L) and nitroglycerin (n=29, Group N) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evaluated by 4 point scale (0 - no pain, 1 - light pain, 2 - mild pain, 3 - severe pain) in 5, 10, 15 and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathways for injection and location of operations were analyzed for their effect on total pain score.
There were no differences between the groups in terms of total pain score (p=0.981). There were no differences in terms of total pain score depending on ASA, education level, location of operation. However, lidocaine was more effective when compared with metoprolol (p=0.015) and nitroglycerin (p=0.001) among groups. Although neither lidocaine nor metoprolol had any difference on pain management when applied from antecubital or dorsal hand vein (p>0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lower pain scores (p=0.001).
We found lidocaine to be the most effective analgesic in decreasing propofol related pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.
丙泊酚注射后疼痛较为常见，可能影响患者舒适度。本研究旨在比较静脉注射硝酸甘油、利多卡因和美托洛尔通过手背静脉或肘前静脉给药对消除丙泊酚注射痛的效果。
147例患者根据所给予的镇痛药分组。美托洛尔（n = 31，M组）、利多卡因（n = 32，L组）和硝酸甘油（n = 29，N组）通过手背静脉或肘前静脉的静脉导管给药。分别于给药后第5、10、15和20秒采用4分制（0分 - 无痛，1分 - 轻度疼痛，2分 - 中度疼痛，3分 - 重度疼痛）评估疼痛程度。分析美国麻醉医师协会（ASA）分级、体重指数（BMI）、患者人口统计学资料、教育水平以及注射途径和手术部位对总疼痛评分的影响。
各组间总疼痛评分无差异（p = 0.981）。根据ASA分级、教育水平、手术部位，总疼痛评分无差异。然而，组间比较时，利多卡因比美托洛尔（p = 0.015）和硝酸甘油（p = 0.001）更有效。尽管利多卡因和美托洛尔从肘前静脉或手背静脉给药时在疼痛控制方面无差异（p>0.05），但从肘前静脉注射硝酸甘油时疼痛评分在统计学上更低（p = 0.001）。
我们发现利多卡因是减轻丙泊酚相关疼痛最有效的镇痛药。因此，我们建议静脉注射利多卡因以减轻手术中丙泊酚相关疼痛。
