Department of Internal Medicine, Creighton University Phoenix, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
Department of Gastroenterology, Creighton University Phoenix, 350 W Thomas Rd, Phoenix, AZ, 85013, USA.
BMC Anesthesiol. 2024 May 28;24(1):190. doi: 10.1186/s12871-024-02573-y.
Propofol for anesthesia has become increasingly popular for endoscopic procedures. However, pain on propofol injection (POPI) remains an issue with administration. The primary endpoint of this study was to identify patient characteristics and factors, such as IV site and gauge, that could predict the occurrence of POPI.
This was a prospective chart review study of 291 patients undergoing endoscopic procedures. The patient's demographics, intravenous (IV) site, and gauge were extrapolated. POPI was scored 0-3: 0 for no pain, 1 for minimal discomfort or awareness of sensation, 2 for discomfort but manageable/tolerable, and 3 for severe discomfort with writhing.
291 patient charts were reviewed. One patient was excluded for a lower extremity IV site. 225 (77.6%) had no pain, 48 (16.6%) grade 1 pain, 16 (5.5%) grade 2 pain, and 1 (0.3%) grade 3 pain. 137, 13, and 140 patients respectively had antecubital (AC), forearm, and hand IVs. Zero patients with an AC IV experienced a score greater than 1. Compared to AC, forearm IVs with pain of 2-3 had a univariate odds ratio (OR) of 11.3 (0.66,1.92; p-value < 0.001), and hand IVs had a univariate OR of 18.8 (2.46,143.3; p-value < 0.001) with a multivariable OR 15.2 (1.93,118.9; p-value 0.004). Patients with anxiety/depression and pain had a univariate OR 2.31 (1.09, 7.27; p-value 0.031) with a multivariable OR 2.85 (1.06, 7.74; p-value 0.039). SSRI/SNRI use had a univariate OR 1.56 (0.57,4.28; p-value 0.38). Alcohol use had a univariate OR 1.24 (0.39,3.91; p-value 0.71). Narcotic use had a Univariate OR 6.18 (1.49,25.6; p-value 0.012). Diabetic patients had a univariate OR of 1.42 (0.45,4.48; p-value 0.55). Chronic pain had a univariate OR of 3.11 (1.04,9.28; p-value 0.042). Females had a univariate OR 0.98 (0.37,2.63; p-value 0.95).
This study identified potential characteristics for having POPI. The incidence of POPI was statistically significant in patients with hand and forearm IVs compared to AC IV sites, larger IV gauges, history of depression/anxiety, history of chronic narcotic use, fibromyalgia, and chronic pain syndromes. This shows the potential of premedicating with analgesics or using AC sites on these select patients to help reduce the risk of POPI.
异丙酚作为麻醉剂在内镜手术中越来越受欢迎。然而，异丙酚注射疼痛（POPI）仍然是一个问题。本研究的主要终点是确定可能预测 POPI 发生的患者特征和因素，如静脉部位和规格。
这是一项对 291 例接受内镜手术的患者进行的前瞻性图表回顾研究。提取患者的人口统计学资料、静脉（IV）部位和规格。POPI 评分 0-3 分：0 分为无痛，1 分为轻微不适或有感觉，2 分为不适但可耐受/可忍受，3 分为严重不适伴扭动。
共回顾了 291 份患者图表。1 名患者因下肢 IV 部位而被排除。225 例（77.6%）无痛，48 例（16.6%）轻度疼痛，16 例（5.5%）中度疼痛，1 例（0.3%）重度疼痛。分别有 137、13 和 140 例患者有肘前（AC）、前臂和手部 IV。AC 静脉无一人疼痛评分大于 1。与 AC 相比，有 2-3 级疼痛的前臂 IV 的单变量优势比（OR）为 11.3（0.66，1.92；p 值<0.001），手部 IV 的 OR 为 18.8（2.46，143.3；p 值<0.001），多变量 OR 为 15.2（1.93，118.9；p 值 0.004）。焦虑/抑郁和疼痛患者的单变量 OR 为 2.31（1.09，7.27；p 值 0.031），多变量 OR 为 2.85（1.06，7.74；p 值 0.039）。SSRIs/SNRIs 使用者的单变量 OR 为 1.56（0.57，4.28；p 值 0.38）。酒精使用者的单变量 OR 为 1.24（0.39，3.91；p 值 0.71）。阿片类药物使用者的单变量 OR 为 6.18（1.49，25.6；p 值 0.012）。糖尿病患者的单变量 OR 为 1.42（0.45，4.48；p 值 0.55）。慢性疼痛患者的单变量 OR 为 3.11（1.04，9.28；p 值 0.042）。女性的单变量 OR 为 0.98（0.37，2.63；p 值 0.95）。
本研究确定了 POPI 的潜在特征。与 AC 静脉部位相比，手部和前臂静脉部位、较大的静脉规格、抑郁/焦虑史、慢性阿片类药物使用史、纤维肌痛和慢性疼痛综合征患者发生 POPI 的发生率具有统计学意义。这表明在这些特定患者中预先使用镇痛药或使用 AC 部位有可能降低 POPI 的风险。
