Sahoo Tapan K, Trivedi Saurabh, Pedhadiva Monika, Gupta Seema, Trivedi Gaurav
Department of Anaesthesia, Chirayu Medical College & Hospital, Bhopal, India.
Department of Trauma & Emergency Medicine, All India Institute of Medical Sciences, Bhopal, India.
Sultan Qaboos Univ Med J. 2024 Nov;24(4):556-561. doi: 10.18295/squmj.11.2024.071. Epub 2024 Nov 27.
Propofol administration is associated with pain, mediated by the activation of vascular endothelium. Hydroxyethyl starch (HES) inhibits endothelial membrane activation by various nociceptive substances. Thus, this study hypothesised that pre-administration of HES can reduce pain on propofol administration. This study aimed to compare the proportion of patients with no pain on propofol administration and to compare the severity of pain and any change in pre- and post-induction haemodynamic variables.
This prospective, randomised, placebo-controlled clinical trial was conducted at Chirayu Medical College & Hospital, Bhopal, India, between August 2023 and December 2023 and included patients undergoing elective surgery under general anaesthesia. Patients were randomly assigned to 3 groups to receive either 100 mL of 6% HES followed by propofol (Group HES), 100 mL normal saline (NS) followed by propofol premixed with 2% lidocaine (Group L) or 100 mL NS followed by propofol induction (Group P).
A total of 339 patients were included. The proportion of patients with no pain on propofol injection was significantly higher in the HES group (n = 75) than in the lignocaine (n = 33) and placebo (n = 13) groups ( <0.0001 each). The median pain scores were 0 (interquartile range [IQR]: 0-1), 1 (IQR: 0-1) and 2 (IQR: 2-3) in the HES, lignocaine and placebo groups, respectively. The proportion of patients with moderate (n = 44) and severe (n = 48) pain scores was significantly higher in the placebo group than in the HES and lignocaine groups ( <0.0001 each).
The proportion of patients experiencing pain on propofol injection was found to be significantly less with the pre-administration of 100 mL 6% HES compared to the pre-administration of lidocaine.
丙泊酚给药会引发疼痛，这是由血管内皮激活介导的。羟乙基淀粉（HES）可抑制多种伤害性物质对内皮细胞膜的激活。因此，本研究假设预先给予HES可减轻丙泊酚给药时的疼痛。本研究旨在比较丙泊酚给药时无痛患者的比例，并比较疼痛的严重程度以及诱导前后血流动力学变量的任何变化。
这项前瞻性、随机、安慰剂对照临床试验于2023年8月至2023年12月在印度博帕尔的奇拉尤医学院和医院进行，纳入了接受全身麻醉下择期手术的患者。患者被随机分为3组，分别接受100 mL 6% HES随后给予丙泊酚（HES组）、100 mL生理盐水（NS）随后给予预混2%利多卡因的丙泊酚（L组）或100 mL NS随后进行丙泊酚诱导（P组）。
共纳入339例患者。HES组（n = 75）丙泊酚注射时无痛患者的比例显著高于利多卡因组（n = 33）和安慰剂组（n = 13）（每组<0.0001）。HES组、利多卡因组和安慰剂组的中位疼痛评分分别为0（四分位间距[IQR]：0 - 1）、1（IQR：0 - 1）和2（IQR：2 - 3）。安慰剂组中度（n = 44）和重度（n = 48）疼痛评分患者的比例显著高于HES组和利多卡因组（每组<0.0001）。
与预先给予利多卡因相比，预先给予100 mL 6% HES时，丙泊酚注射时出现疼痛的患者比例显著更低。
