Yuan Shi-Ying, Luo Tian-Yuan, Liu Zhen, Lin Yun
Department of Anesthesiology and Intensive Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Anesthesiology, Affiliated Hospital of Zunyi Medical College, Zunyi, 563000, China.
J Huazhong Univ Sci Technolog Med Sci. 2016 Apr;36(2):249-253. doi: 10.1007/s11596-016-1575-x. Epub 2016 Apr 13.
Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA I-II adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 mL (P100 group), 250 mL (P250 group), 500 mL (P500 group), 0.9% saline 500 mL (N500 group) or Gelofusine 500 mL (G500 group) was completed within 30 min, respectively, Propofol (0.5 mg/kg, 1%) was injected at a rate of 0.5 mL/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively (P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups (P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group (62.5%) (N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group (P<0.05) and G500 group (P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 mL before propofol injection is effective in alleviating propofol-induced pain.
丙泊酚注射痛仍是一个常见的临床问题。既往研究表明，在注射部位皮肤涂抹硝酸甘油软膏可减轻丙泊酚注射痛，这启发我们测试液体预负荷诱导的静脉血管扩张是否能减轻疼痛。比较了不同类型或体积的液体预负荷。200例ASA I-II级成年患者被随机分为五组，每组40例。在手背或手腕建立20G套管。当分别在30分钟内完成用100mL复方电解质注射液（P100组）、250mL（P250组）、500mL（P500组）、500mL 0.9%氯化钠溶液（N500组）或500mL琥珀酰明胶（G500组）进行液体预负荷后，以0.5mL/s的速度注射丙泊酚（0.5mg/kg，1%）。一名盲法研究者用四点量表评估疼痛。P100组、P250组和P500组的疼痛发生率分别为87.5%、57.5%和35%（P<0.05）。P500组的疼痛强度中位数评分显著低于P250组和P100组（分别为P<0.05和P<0.01）。不同类型溶液预负荷效果的比较表明，N500组的疼痛发生率最高（62.5%）（N500组与P500组比较，P=0.014；N500组与G500组比较，P=0.007）。N500组的疼痛强度中位数评分高于P500组（P<0.05）和G500组（P<0.05）。P500组和G500组之间无显著差异。提示在注射丙泊酚前用500mL复方电解质注射液或琥珀酰明胶进行预负荷可有效减轻丙泊酚诱导的疼痛。
