Yang Fan, Wang Jie, Zhang Huiwen, Zhang Yonghai, Yang Wanji, Gao Ran, Yu Jingfang, Chen Xuexin, Ma Hanxiang
Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 75004, People's Republic of China.
Department of Anesthesiology, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, 650051, People's Republic of China.
Drug Des Devel Ther. 2024 Dec 7;18:5873-5880. doi: 10.2147/DDDT.S484486. eCollection 2024.
In China, the majority of hysteroscopic procedures require moderate sedation and analgesia. The efficacy of intravenous lidocaine in reducing the need for sedatives and alleviating perioperative pain during hysteroscopy remains equivocal. This study aims to determine whether the intravenous administration of lidocaine can reduce the required dose of propofol and enhance perioperative pain management.
We conducted a prospective, single-center, double-blind randomized controlled trial involving patients with ASA I-II undergoing hysteroscopy. Forty patients were randomly assigned in a 1:1 ratio to either receive an intravenous bolus dose of 1.5 mg/kg lidocaine, followed by a continuous intravenous infusion at 4 mg/kg/h until the conclusion of the procedure, or an equivalent volume of normal saline. Propofol was then titrated to maintain a MOAA/S score of ≤ 2.
Compared with the control group, the lidocaine group showed a 13.8% decrease in the total dose of propofol (140.0[120.0, 155.0] mg vs 162.5[140.0, 197.5] mg), which was statistically significant ( = 0.014). The induction dose of propofol was 1.37 (1.29, 1.56) mg/kg in the lidocaine group and 1.61 (1.48, 1.94) mg/kg in the control group, respectively ( = 0.001). However, no significant differences were observed between the groups regarding the supplemental dose of propofol ( = 0.062), the number of involuntary movements during hysteroscopy ( = 0.384), or postoperative pain scores (T0: = 0.628; T1: = 0.886; T2: = 0.711). Additionally, the incidence of intraoperative hypoxia ( = 1.000) and fatigue scores (T0: = 0.878; T1: = 0.401; T2: = 0.056) between the two groups were not statistically significant.
Intravenous lidocaine reduces the dose requirements of propofol during the induction phase of anesthesia. However, it does not have a significant influence on alleviating intraoperative and postoperative pain during hysteroscopic procedures.
在中国，大多数宫腔镜手术需要适度的镇静和镇痛。静脉注射利多卡因在减少宫腔镜检查期间镇静剂需求和减轻围手术期疼痛方面的疗效仍不明确。本研究旨在确定静脉注射利多卡因是否能减少丙泊酚的所需剂量并加强围手术期疼痛管理。
我们进行了一项前瞻性、单中心、双盲随机对照试验，纳入接受宫腔镜检查的ASA I-II级患者。40例患者按1:1比例随机分组，分别接受静脉推注1.5mg/kg利多卡因，随后以4mg/kg/h持续静脉输注直至手术结束，或等量生理盐水。然后滴定丙泊酚以维持MOAA/S评分≤2。
与对照组相比，利多卡因组丙泊酚总剂量降低了13.8%（140.0[120.0, 155.0]mg对162.5[140.0, 197.5]mg），差异有统计学意义（P = 0.014）。利多卡因组丙泊酚诱导剂量为1.37（1.29, 1.56）mg/kg，对照组为1.61（1.48, 1.94）mg/kg，差异有统计学意义（P = 0.001）。然而，两组在丙泊酚补充剂量（P = 0.062）、宫腔镜检查期间不自主运动次数（P = 0.384）或术后疼痛评分方面（T0：P = 0.628；T1：P = 0.886；T2：P = 0.711）未观察到显著差异。此外，两组术中低氧发生率（P = 1.000）和疲劳评分（T0：P = 0.878；T1：P = 0.401；T2：P = 0.056）差异无统计学意义。
静脉注射利多卡因可降低麻醉诱导期丙泊酚的剂量需求。然而，它对减轻宫腔镜手术期间的术中及术后疼痛没有显著影响。
