鞘内注射低剂量氯胺酮预处理减轻丙泊酚注射痛的随机对照研究
Pretreatment with Low-Dose Esketamine for Reduction of Propofol Injection Pain: A Randomized Controlled Trial.
机构信息
Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui, Shanghai 200031, China.
出版信息
Pain Res Manag. 2022 Aug 2;2022:4289905. doi: 10.1155/2022/4289905. eCollection 2022.
BACKGROUND
Propofol-induced injection pain is a common adverse effect during the induction of general anesthesia. The purpose of this study is to investigate the effect of low-dose esketamine in preventing propofol injection pain.
METHODS
In this double-blind, randomized, controlled trial, patients scheduled for elective ear surgery under general anesthesia received either normal saline (NS), or 40 mg lidocaine, or 0.15 mg/kg esketamine 30 seconds before manual injection of propofol. The primary outcome of this study was the incidence of propofol injection pain. The secondary outcomes included injection pain score, vital signs, total dosage of vasoactive drugs used within 5 minutes after induction, and adverse events related to drugs.
RESULTS
A total of 105 patients were included. Compared with the NS group (67%), pretreatment with esketamine and lidocaine significantly reduced the incidence of injection pain to 29% and 33%, respectively (both < 0.05); however, no significant difference was found between the esketamine and lidocaine groups. The median of injection pain score was significantly lower in the esketamine and lidocaine groups (both median (interquartile range) = 0 (0-1)) than that in the NS group (1 (0-2); < 0.05). In addition, compared with the NS and lidocaine groups, preinjection esketamine provided more stable hemodynamic parameters within 5 minutes after induction ( < 0.05). No statistical difference was found in adverse events among the three groups.
CONCLUSIONS
Pretreatment with a low-dose esketamine can not only reduce the incidence of propofol injection pain but also provide a more stable circulation in patients after anesthesia induction. This convenient, well-tolerated, and economic treatment appears as an option to be routinely applied in clinic practice. This trial is registered with https://www.chictr.org.cn/showproj.aspx?proj=136690 (the number for the trial registration isChiCTR2100052742).
背景
异丙酚诱导注射痛是全身麻醉诱导期间的常见不良反应。本研究旨在探讨小剂量氯胺酮预防异丙酚注射痛的效果。
方法
在这项双盲、随机、对照试验中，接受全身麻醉下择期耳部手术的患者在手动注射异丙酚前 30 秒分别接受生理盐水（NS）、40mg 利多卡因或 0.15mg/kg 氯胺酮。本研究的主要结局是异丙酚注射痛的发生率。次要结局包括注射痛评分、生命体征、诱导后 5 分钟内使用的血管活性药物的总剂量以及与药物相关的不良事件。
结果
共纳入 105 例患者。与 NS 组（67%）相比，氯胺酮和利多卡因预处理可使注射痛的发生率分别显著降低至 29%和 33%（均<0.05）；但氯胺酮组与利多卡因组之间无显著差异。氯胺酮组和利多卡因组的注射痛评分中位数均明显低于 NS 组（均为中位数（四分位距）=0（0-1））（均<0.05）。此外，与 NS 组和利多卡因组相比，氯胺酮预处理可在诱导后 5 分钟内提供更稳定的血流动力学参数（均<0.05）。三组间的不良事件无统计学差异。
结论
小剂量氯胺酮预处理不仅可以降低异丙酚注射痛的发生率，而且可以为麻醉诱导后患者提供更稳定的循环。这种方便、耐受性良好且经济的治疗方法似乎是常规应用于临床实践的选择。本试验在 https://www.chictr.org.cn/showproj.aspx?proj=136690（注册号为 ChiCTR2100052742）上注册。
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