Lu Yayun, Gu Yaping, Liu Lihua, Tang Xuefeng, Xia Qing, Xu Zhiyue
Center of Gastrointestinal Endoscopy, Huadong Sanatorium, Wuxi, China.
Department of Anesthesiology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China.
Front Med (Lausanne). 2021 May 7;8:590465. doi: 10.3389/fmed.2021.590465. eCollection 2021.
Propofol injection pain, despite various interventions, still occurs during the anesthesia induction and causes intense discomfort and anxiety in patients. This study aimed to explore the effect of intravenous dexmedetomidine on propofol injection pain prior to anesthesia induction with propofol at 4°C. A total of 251 patients (American Society of Anesthesiologists I-II) who underwent oral and maxillofacial surgery were randomly assigned to a combination group ( = 63), lidocaine group ( = 62), dexmedetomidine group ( = 63), and placebo-control group ( = 63); they received 0.5 ug/kg dexmedetomidine prior to anesthesia induction with propofol at 4°C, 40 mg lidocaine, 0.5 ug/kg dexmedetomidine prior to anesthesia induction, and normal saline, respectively. Incidence of pain, pain intensity, and reaction to the pain stimulus were evaluated by using verbal categorial scoring (VCS), a numerical rating scale (NRS), and the Surgical Pleth Index (SPI), respectively. In addition, hemodynamic parameters such as heart rate (HR) and mean arterial pressure (MAP) were also measured. The VCS and NRS were evaluated at 5 s after propofol injection. In addition, SPI, HR, and MAP were evaluated at three time points (before anesthesia induction and 5 and 30 s after propofol injection). The incidence of pain in the combination group (51%) was significantly lower than that in the lidocaine group (71%), dexmedetomidine group (67%), or placebo-control group (94%) ( < 0.001). VCS and NRS scores in the combination group were also lower compared with the other three groups ( < 0.001), with no statistically significant differences between the lidocaine group and dexmedetomidine group ( > 0.05). The SPI of the combination group decreased significantly in comparison with the other three groups at 5 s after propofol injection ( = 96.23, < 0.001) and 30 s after propofol injection ( = 4.46, = 0.005). Further comparisons between HR and MAP revealed no significant differences across the groups ( > 0.05). Because of the sedative nature of dexmedetomidine and analgesic effect of low temperature, this study showed that intravenous dexmedetomidine prior to anesthesia induction with propofol at 4°C is highly effective in attenuating the incidence and severity of pain during injection compared with lidocaine (40 mg), dexmedetomidine 0.5 ug/kg) and placebo. This approach was not associated with any anesthesia complications. ClinicalTrials.gov, identifier: ChiCTR-2000034663.
尽管采取了各种干预措施，但丙泊酚注射痛在麻醉诱导期间仍会发生，并给患者带来强烈不适和焦虑。本研究旨在探讨静脉注射右美托咪定对4℃丙泊酚麻醉诱导前丙泊酚注射痛的影响。共有251例接受口腔颌面外科手术的患者（美国麻醉医师协会I-II级）被随机分为联合组（n = 63）、利多卡因组（n = 62）、右美托咪定组（n = 63）和安慰剂对照组（n = 63）；他们分别在4℃丙泊酚麻醉诱导前接受0.5μg/kg右美托咪定、40mg利多卡因、麻醉诱导前0.5μg/kg右美托咪定和生理盐水。分别采用言语分类评分（VCS）、数字评分量表（NRS）和手术容积指数（SPI）评估疼痛发生率、疼痛强度和对疼痛刺激的反应。此外，还测量了心率（HR）和平均动脉压（MAP）等血流动力学参数。在丙泊酚注射后5秒评估VCS和NRS。此外，在三个时间点（麻醉诱导前、丙泊酚注射后5秒和30秒）评估SPI、HR和MAP。联合组的疼痛发生率（51%）显著低于利多卡因组（71%）、右美托咪定组（67%）或安慰剂对照组（94%）（P < 0.001）。联合组的VCS和NRS评分也低于其他三组（P < 0.001），利多卡因组和右美托咪定组之间无统计学显著差异（P > 0.05）。联合组的SPI在丙泊酚注射后5秒（P = 96.23，P < 0.001）和丙泊酚注射后30秒（P = 4.46，P = 0.005）与其他三组相比显著降低。HR和MAP的进一步比较显示各组之间无显著差异（P > 0.05）。由于右美托咪定的镇静性质和低温的镇痛作用，本研究表明，与利多卡因（40mg）、右美托咪定0.5μg/kg）和安慰剂相比，4℃丙泊酚麻醉诱导前静脉注射右美托咪定在减轻注射期间疼痛的发生率和严重程度方面非常有效。这种方法未伴有任何麻醉并发症。ClinicalTrials.gov标识符：ChiCTR-2000034663。
