混合0.3%利多卡因对丙泊酚注射痛的影响
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摘要
目的:探讨混合利多卡因抑制丙泊酚注射痛的最佳浓度,并对其有效性及安全性进行评价。方法:收集无痛人工流产手术病人(ASAⅠ～Ⅱ级)809例,采用阶梯式递增、递减模式,滴定混合利多卡因的最佳浓度。病人静注舒芬太尼后随机分为3组,空白组(A组)静注1%丙泊酚;对照组(B组)预注利多卡因40 mg后,静注1%丙泊酚;试验组(C组)注射0.3%利多卡因及0.83%丙泊酚的混合液。注射期间对注射痛评分,同时观察记录注药前后血压、心率(HR)及氧饱和度(SpO_2)、清醒时间及呼吸、循环抑制、恶心呕吐等不良反应,术后调查病人满意度。结果:3组病人用药前舒张压差异无统计学意义(P>0.05),B组、C组收缩压均高于A组(P<0.01),用药后1 min、3 min 3组收缩压、舒张压均较术前明显降低(P<0.01),组间比较差异无统计学意义(P>0.05);3组病人HR用药前无差别,用药后1 min均下降(P<0.05～P<0.01),用药后3 min A组HR仍低于用药前(P<0.05),B组、C组HR均低于用药前,但差异无统计学意义(P>0.05);用药后C组HR高于B组(P<0.05);SpO_2用药后均明显降低(P<0.01),但组间差异无统计学意义(P>0.05),3组用药后3 min SpO_2较用药后1min明显升高(P<0.01),且B组、C组明显高于A组(P<0.01)。3组疼痛发生率比较:C组B组>A组(P<0.05)。3组病人低SpO_2、低血压、低心率、恶心呕吐及体动等不良反应发生率差异均无统计学意义(P>0.05)。结论:混合0.3%利多卡因的丙泊酚可以安全、有效消除注射痛。
Objective:To investigate the optimal concentration of lidocaine in inhibiting the propofol injection pain,and evaluate its efficacy and safety.Methods:The optimal concentration of lidocaine in painless artifical abortion patients(ASA Ⅰ to Ⅱ)was detected using step by step increasing or decreasing mode.The patients injected with sufentanil were randomly divided into the blank group(group A injected with 1% propofol),control group(group B injected with 1% propofol after 40 mg of lidocain preinjection) and experimental group(group C injected with the mixture of 0.3% lidocaine and 0.83% propofol).The pain scores in three groups were evaluated during injection period.The blood pressure before and after injection,heart rate(HR) and SpO_2,waking time,respiratory or circulatory inhibition,nausea or vomiting and satisfaction degree in three groups were analyzed.Results:Before medication,the differences of diastolic pressure among three groups were not statistically significant(P>0.05),and the levels of systolic pressure in group B and group C were higher than that in group C(P<0.01).After 1 min and 3 min of medication,the levels of diastolic pressure and systolic pressure in three groups significantly decreased compared with before medication(P<0.01),and the differences of those among three groups were not statistically significant(P>0.05).There was no difference in HR among three groups before medication,the HR in three groups after 1 min of medication significantly decreased(P<0.05 to P<0.01).After 3 min of medication,the HR in group A was lower than before medication(P<0.05).After 3 min of medication,the HR in group B and group C were lower than before medication,and the difference of which was not statistically significant(P>0.05).After medication,the HR in group C was significantly higher than that in group B(P<0.05).After medication,the SpO_2 levels in three groups significantly decreased(P<0.01),but the differences of which among three groups were not statistically significant(P>0.05).After 3 min of medication,the SpO_2 levels in three groups significantly increased compared with after 1 min of medication(P<0.01),and which in group B and group C were higher than that in group A(P<0.01).The incidence rates of severe pain and satisfaction degree in group C,group B and group A gradually increased in turn,respectively(P<0.05).The differences of the incidence rates of low SpO_2,blood pressure and heart rate,nausea,vomiting and movement among three groups were not statistically significant(P>0.05).Conclusions:The mixture of 0.3% lidocaine and 0.83% propofol can safely and effectively eliminate the injection pain of propofol.
Objective:To investigate the optimal concentration of lidocaine in inhibiting the propofol injection pain,and evaluate its efficacy and safety.Methods:The optimal concentration of lidocaine in painless artifical abortion patients(ASA Ⅰ to Ⅱ)was detected using step by step increasing or decreasing mode.The patients injected with sufentanil were randomly divided into the blank group(group A injected with 1% propofol),control group(group B injected with 1% propofol after 40 mg of lidocain preinjection) and experimental group(group C injected with the mixture of 0.3% lidocaine and 0.83% propofol).The pain scores in three groups were evaluated during injection period.The blood pressure before and after injection,heart rate(HR) and SpO_2,waking time,respiratory or circulatory inhibition,nausea or vomiting and satisfaction degree in three groups were analyzed.Results:Before medication,the differences of diastolic pressure among three groups were not statistically significant(P>0.05),and the levels of systolic pressure in group B and group C were higher than that in group C(P<0.01).After 1 min and 3 min of medication,the levels of diastolic pressure and systolic pressure in three groups significantly decreased compared with before medication(P<0.01),and the differences of those among three groups were not statistically significant(P>0.05).There was no difference in HR among three groups before medication,the HR in three groups after 1 min of medication significantly decreased(P<0.05 to P<0.01).After 3 min of medication,the HR in group A was lower than before medication(P<0.05).After 3 min of medication,the HR in group B and group C were lower than before medication,and the difference of which was not statistically significant(P>0.05).After medication,the HR in group C was significantly higher than that in group B(P<0.05).After medication,the SpO_2 levels in three groups significantly decreased(P<0.01),but the differences of which among three groups were not statistically significant(P>0.05).After 3 min of medication,the SpO_2 levels in three groups significantly increased compared with after 1 min of medication(P<0.01),and which in group B and group C were higher than that in group A(P<0.01).The incidence rates of severe pain and satisfaction degree in group C,group B and group A gradually increased in turn,respectively(P<0.05).The differences of the incidence rates of low SpO_2,blood pressure and heart rate,nausea,vomiting and movement among three groups were not statistically significant(P>0.05).Conclusions:The mixture of 0.3% lidocaine and 0.83% propofol can safely and effectively eliminate the injection pain of propofol.
引文
[1] AGARWAL A,RAZA M,DHIRAAJ S,et al.Pain during injection of propofol:the effect of prior administration of butorphanol[J].Anesth Analg,2004,99(1):117.
[2] LEE P,RUSSELL WJ.Preventing pain on injection of propofol:a comparison between lignocaine pretreatment and lignocaine added to propofol[J].Anaesth Intensive Care,2004,32(4):482.
[3] KIZILCIK N,MENDA F,BILGEN S,et al.Effects of afentanyl-propofol mixture on propofol injection pain:a randomized clinical trial[J].Korean J Anesthesiol,2015,68(6):556.
[4] ZHAO GY,GUO Y,BAO SM,et al.Prevention of propofol induced pain in children:pretreatment with small doses of ketamine[J].J Clin Anesth,2012,24(4):284.
[5] 闫诺,杨程.帕瑞昔布钠防治丙泊酚注射痛的临床观察[J].临床麻醉学杂志,2012,28(1):49.
[6] SAPATE M,ANDURKAR U,MARKANDEYA M,et al.To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lidocaine[J].Rev Bras Anestesiol,2015,65(6):466.
[7] GALGON RE,STRUBE P,HEIER J,et al.Magnesium sulfate with lidocaine for preventing propofol injection pain:a randomized,double-blind,placebo-controlled trial[J].J Anesth,2015,29(2):206.
[8] GHARAVI M,SABZEVARI A,GHORBANIAN E,et al.Effect of lidocaine volume and concentration on preventing incidence and severity of propofol injection pain [J].Iran Red Crescent Med J,2014,16(3):e16099.
[9] BACHMANN-MENNENGA B,OHLMER A,BOEDEKER RH,et al.Preventing pain during injection of propofol:effects of a new emulsion with lidocaine addition[J].Eur J Anaesthesiol,2007,24(1):33.
[10] WEBER U,KRAMMEL M,LINKE S,et al.Intravenous lidocaine increases the depth of anaesthesia of propofol for skin incision-a randomised controlled trial[J].Acta Anaesthesiol Scand,2015,59(3):310.
[11] AHN E,KANG H,CHOI GJ.Intravenous lidocaine for effective pain relief after a laparoscopic colectomy:a prospective,randomized,double-blind,placebo-controlled study[J].Int Surg,2015,100(3):394.
[12] PEIXOTO RD,HAWLEY P.Intravenous lidocaine for cancer pain without electrocardiographic monitoring:a retrospective review[J].J Palliat Med,2015,18(4):373.
[13] HUTSON P,BACKONJA M,KNURR H.Intravenous lidocaine for neuropathic pain:a retrospective analysis of tolerability and efficacy[J].Pain Med,2015,16(3):531.
[14] 徐学武,许文秀,王宝宁,等.丙泊酚复合不同浓度利多卡因预防注射痛的临床研究[J].临床麻醉学杂志,2012,28(4):378.
[2] LEE P,RUSSELL WJ.Preventing pain on injection of propofol:a comparison between lignocaine pretreatment and lignocaine added to propofol[J].Anaesth Intensive Care,2004,32(4):482.
[3] KIZILCIK N,MENDA F,BILGEN S,et al.Effects of afentanyl-propofol mixture on propofol injection pain:a randomized clinical trial[J].Korean J Anesthesiol,2015,68(6):556.
[4] ZHAO GY,GUO Y,BAO SM,et al.Prevention of propofol induced pain in children:pretreatment with small doses of ketamine[J].J Clin Anesth,2012,24(4):284.
[5] 闫诺,杨程.帕瑞昔布钠防治丙泊酚注射痛的临床观察[J].临床麻醉学杂志,2012,28(1):49.
[6] SAPATE M,ANDURKAR U,MARKANDEYA M,et al.To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lidocaine[J].Rev Bras Anestesiol,2015,65(6):466.
[7] GALGON RE,STRUBE P,HEIER J,et al.Magnesium sulfate with lidocaine for preventing propofol injection pain:a randomized,double-blind,placebo-controlled trial[J].J Anesth,2015,29(2):206.
[8] GHARAVI M,SABZEVARI A,GHORBANIAN E,et al.Effect of lidocaine volume and concentration on preventing incidence and severity of propofol injection pain [J].Iran Red Crescent Med J,2014,16(3):e16099.
[9] BACHMANN-MENNENGA B,OHLMER A,BOEDEKER RH,et al.Preventing pain during injection of propofol:effects of a new emulsion with lidocaine addition[J].Eur J Anaesthesiol,2007,24(1):33.
[10] WEBER U,KRAMMEL M,LINKE S,et al.Intravenous lidocaine increases the depth of anaesthesia of propofol for skin incision-a randomised controlled trial[J].Acta Anaesthesiol Scand,2015,59(3):310.
[11] AHN E,KANG H,CHOI GJ.Intravenous lidocaine for effective pain relief after a laparoscopic colectomy:a prospective,randomized,double-blind,placebo-controlled study[J].Int Surg,2015,100(3):394.
[12] PEIXOTO RD,HAWLEY P.Intravenous lidocaine for cancer pain without electrocardiographic monitoring:a retrospective review[J].J Palliat Med,2015,18(4):373.
[13] HUTSON P,BACKONJA M,KNURR H.Intravenous lidocaine for neuropathic pain:a retrospective analysis of tolerability and efficacy[J].Pain Med,2015,16(3):531.
[14] 徐学武,许文秀,王宝宁,等.丙泊酚复合不同浓度利多卡因预防注射痛的临床研究[J].临床麻醉学杂志,2012,28(4):378.