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      Effect of lidocaine (40 mg) mixed to prevent injection pain of propofol on the intubating conditions and onset time of rocuronium

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          Abstract

          Background

          To analyze how lidocaine 40 mg mixed prevents injection pain of propofol affects the onset time of rocuronium, tracheal intubating conditions and intubation related hemodynamic changes.

          Methods

          This study consisted of 70 patients with an American Society of Anesthesiologists (ASA) physical status class 1 or 2 for general anesthesia. All the patients were randomly allocated into two groups: propofol 2 mg/kg plus normal saline 2 ml (Group C) and propofol 2 mg/kg plus 2% lidocaine 40 mg (Group L). Each group was administrated intravenously during induction and the patient was intubated 1 minute after an injection of 0.6 mg/kg of rocuronium. The time at disappearance of the first twitch and intubation scores were recorded. Also, blood pressure and heart rate were measured at the baseline, after intravenous injection of propofol, before intubation, and at 0, 1, 2, 3 and 5 minutes after intubation.

          Results

          There were no significant differences between group C and L (P > 0.05).

          Conclusions

          40 mg of lidocaine mixed with propofol to prevent injection pain did not affect the onset time of rocuronium, intubating conditions and intubation related hemodynamic changes.

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          Most cited references25

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          Prevention of pain on injection with propofol: a quantitative systematic review.

          The best intervention to prevent pain on injection with propofol is unknown. We conducted a systematic literature search (Medline, Embase, Cochrane Library, bibliographies, hand searching, any language, up to September 1999) for full reports of randomized comparisons of analgesic interventions with placebo to prevent that pain. We analyzed data from 6264 patients (mostly adults) of 56 reports. On average, 70% of the patients reported pain on injection. Fifteen drugs, 12 physical measurements, and combinations were tested. With IV lidocaine 40 mg, given with a tourniquet 30 to 120 s before the injection of propofol, the number of patients needed to be treated (NNT) to prevent pain in one who would have had pain had they received placebo was 1.6. The closest to this came meperidine 40 mg with tourniquet (NNT 1.9) and metoclopramide 10 mg with tourniquet (NNT 2.2). With lidocaine mixed with propofol, the best NNT was 2.4; with IV alfentanil or fentanyl, it was 3 to 4. IV lidocaine before the injection of propofol was less analgesic. Temperature had no significant effect. There was a lack of data for all other interventions to allow meaningful conclusions. The diameter of venous catheters and speed of injection had no impact on pain. IV lidocaine (0.5 mg/kg) should be given with a rubber tourniquet on the forearm, 30 to 120 s before the injection of propofol; lidocaine will prevent pain in approximately 60% of the patients treated in this manner.
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            Pain on injection of propofol.

            Pain on injection of propofol is a common problem, the cause of which remains unknown. The chemical properties and preparation of propofol, proposed mechanisms for the cause of the pain and clinical strategies to prevent pain on injection of propofol are reviewed in the hope of shedding some light on the subject.
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              Propofol: clinical strategies for preventing the pain of injection.

              Eight modes of administration of propofol were assessed in order to minimise the pain of injection. An intravenous bolus injection in the antecubital fossa was the only approach that caused no pain. When administered intravenously in the dorsum of the hand the pain score and the number of patients who experienced pain was reduced significantly by mixing the agent with lignocaine when compared with a bolus injection. Slowing the speed of injection caused the greatest discomfort. An indirect biochemical mechanism for the pain is proposed.
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                Author and article information

                Journal
                Korean J Anesthesiol
                Korean J Anesthesiol
                KJAE
                Korean Journal of Anesthesiology
                The Korean Society of Anesthesiologists
                2005-6419
                2005-7563
                January 2013
                21 January 2013
                : 64
                : 1
                : 29-33
                Affiliations
                Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
                Author notes
                Corresponding author: Yoon-Hee Kim, M.D., Department of Anesthesiology and Pain Medicine, Chungnam National University School of Medicine, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7840, Fax: 82-42-280-7968, yhkim0404@ 123456cnu.ac.kr
                Article
                10.4097/kjae.2013.64.1.29
                3558645
                23372883
                076e1429-35ea-4d4a-89b2-798638067b37
                Copyright © the Korean Society of Anesthesiologists, 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 February 2012
                : 29 June 2012
                : 11 July 2012
                Categories
                Clinical Research Article

                Anesthesiology & Pain management
                lidocaine,neuromuscular blockade,propofol,rocuronium
                Anesthesiology & Pain management
                lidocaine, neuromuscular blockade, propofol, rocuronium

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