Cheng Dabin, Liu Lu, Hu Zheng
Dabin Cheng, Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China.
Lu Liu, Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China.
Pak J Med Sci. 2017 May-Jun;33(3):752-756. doi: 10.12669/pjms.333.12026.
Propofol is a new anesthetic agent in clinical practice, but randomized double-blinded prospective studies on its role in pediatric anesthesia remain limited. We aimed to compare the preventive effects of pre-injected lidocaine or ketamine and its pre-mixture on the anesthesia-induced injection pain of propofol using a randomized double-blinded prospective method, and to compare the outcomes with those of medium-/long-chain propofol (M/LCT).
A total of 360 pediatric patients (aged 5-12 years old) who received elective surgery were randomly divided into six groups (n= 60) as follows. S group: control group; L group: lidocaine group; L + P group: lidocaine + propofol group; K group: ketamine group; K + P group: ketamine + propofol group; M group: M/LCT group. After the drug fluid completely entered the cubital vein, the venous access was closed. During propofol injection, the injection pain was scored using the VRS 4-point scale. Meanwhile, the heart rates before and during injection were recorded, the adverse reactions during and after injection were observed, and the incidence rate and degree of pain were evaluated.
The VRS 4-point scale showed that the incidence rates of injection pain of S group, L group, L + P group, K group, K + P group and M group were 78.3%, 66.67%, 51.66%, 43.33%, 48.33% and 45% respectively. The incidence rates of injection pain of all experimental groups were significantly lower than that of S group (P<0.01). The incidence rates of injection pain of L + P group, K group, K + P group and M group were significantly lower than that of L group (P<0.05). The differences among the other groups were not statistically significant.
Intravenous pre-injection of lidocaine, ketamine or those mixed with propofol can all significantly reduce the incidence rate of injection pain of propofol.
丙泊酚是临床实践中的一种新型麻醉剂，但关于其在小儿麻醉中作用的随机双盲前瞻性研究仍然有限。我们旨在采用随机双盲前瞻性方法比较预先注射利多卡因或氯胺酮及其预混剂对丙泊酚麻醉诱导注射痛的预防效果，并与中/长链丙泊酚（M/LCT）的效果进行比较。
总共360例接受择期手术的小儿患者（年龄5 - 12岁）被随机分为六组（n = 60），如下所示。S组：对照组；L组：利多卡因组；L + P组：利多卡因 + 丙泊酚组；K组：氯胺酮组；K + P组：氯胺酮 + 丙泊酚组；M组：M/LCT组。待药液完全进入肘静脉后，关闭静脉通路。在丙泊酚注射期间，使用视觉模拟评分法（VRS）4分制对注射痛进行评分。同时，记录注射前和注射期间的心率，观察注射期间及注射后的不良反应，并评估疼痛的发生率和程度。
VRS 4分制显示，S组、L组、L + P组、K组、K + P组和M组的注射痛发生率分别为78.3%、66.67%、51.66%、43.33%、48.33%和45%。所有实验组的注射痛发生率均显著低于S组（P < 0.01）。L + P组、K组、K + P组和M组的注射痛发生率显著低于L组（P < 0.05）。其他组之间的差异无统计学意义。
静脉预先注射利多卡因、氯胺酮或它们与丙泊酚的混合剂均可显著降低丙泊酚注射痛的发生率。
