Prevention of propofol-induced pain in children: pretreatment with small doses of ketamine

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• 作者：Guang-yi Zhao ; MD (Associate Professor of Anesthesia) ; Yao Guo ; MD (Assistant Professor of Anesthesia) ; Shu-min Bao ; MD (Resident in Anesthesia) ; Ling-xin Meng ; MD ; PhD ; ^{menglx_sj@126.com} (Professor ; Chairman) ; Li-hong Zhang ; MD ; PhD (Professor of Anesthesia)
• 关键词：Analgesia ; Injection pain ; Ketamine ; Pediatric ; Propofol
• 刊名：Journal of Clinical Anesthesia
• 出版年：2012
• 期刊代码：147_09528180
• 类别：med
• 出版时间：June, 2012
• 卷：24
• 期：4
• 页码：284-288
• 文件大小：133 K

摘要

Study Objective

To evaluate the efficacy of ketamine in preventing propofol injection pain in children.

Design

Prospective, randomized, double-blinded, placebo-controlled study.

Setting

University-affiliated hospital.

Patients

192 ASA physical status 1 and 2 pediatric patients.

Interventions

Patients were randomly assigned to 4 groups. Group S (control) received normal saline as a placebo; Group K1, Group K3, and Group K5 received 0.1 mg/kg, 0.3 mg/kg, and 0.5 mg/kg of ketamine, respectively. Fifteen seconds after the ketamine injection, patients were injected with propofol at a rate of 12 mL/min until loss-of-eyelash reflex.

Measurement

Pain was evaluated blindly at the time of induction using a 4-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Adverse effects were recorded. Characteristics of induction of anesthesia, such as dose of propofol and time from propofol injection to loss of consciousness (induction duration), were noted.

Main Results

39 (84.8%) Group S (control) patients had pain. Pretreatment with ketamine reduced the frequency of pain significantly to 56.5%, 17.0%, and 14.9%in Groups K1, K3, and K5, respectively. Furthermore, the frequency of moderate and severe pain in Group K1 (21.8%), Group K3 (6.4%), and Group K5 (4.3%) was significantly (P < 0.001, respectively) reduced compared with Group S (76.1%). Moreover, the dose of propofol for induction in Group K5 was smaller than in Group S, Group K1, and Group K3 (P < 0.05). One patient in Group K5 had emergence agitation.

Conclusion

Pretreatment with a small dose of ketamine (0.3 mg/kg) reduced the frequency and intensity of propofol injection pain without severe adverse effects.