Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin / Lidocaína é mais eficaz do que metoprolol e nitroglicerina para o alívio da dor relacionada à injeção de propofol

ABSTRACTBACKGROUND AND OBJECTIVES: Injection pain after propofol administration is common and maydisturb patients' comfort. The aim of this study was to compare effectiveness of intravenous(iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand orantecubital vein on eliminating propofol injection pain.METHOD: There were 147 patients and they were grouped according to the analgesic adminis-tered. Metoprolol (n = 31, Group M), lidocaine (n = 32, Group L) and nitroglycerin (n = 29, GroupN) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evalu-ated by 4 point scale (0 - no pain, 1 --- light pain, 2 --- mild pain, 3 --- severe pain) in 5, 10, 15and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathwaysfor injection and location of operations were analyzed for their effect on total pain score.RESULTS: There were no differences between the groups in terms of total pain score (p = 0.981).There were no differences in terms of total pain score depending on ASA, education level,location of operation. However, lidocaine was more effective when compared with metoprolol(p = 0.015) and nitroglycerin (p = 0.001) among groups. Although neither lidocaine nor metopro-lol had any difference on pain management when applied from antecubital or dorsal hand vein(p > 0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lowerpain scores (p = 0.001).CONCLUSION: We found lidocaine to be the most effective analgesic in decreasing propofolrelated pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.

RESUMOJUSTIFICATIVA E OBJETIVOS: A dor no local da injeção após a administração de propofol é comum e pode causar desconforto nos pacientes. O objetivo deste estudo foi comparar a eficácia de nitroglicerina, lidocaína e metoprolol, aplicados intravenosamente através de veias do dorso das mãos ou antecubitais, para eliminar a dor causada pela injeção de propofol.MÉTODOS: Foram alocados em grupos 147 pacientes de acordo com o analgésico administrado: metoprolol (n = 31, Grupo M), lidocaína (n = 32, Grupo L) e nitroglicerina (n = 29, Grupo N). Os analgésicos foram aplicados via cateter intravenoso em veia do dorso da mão ou antecubital. A dor foi avaliada com uma escala de quatro pontos (0 = sem dor, 1 = dor leve, 2 = dor moderada, 3 = dor intensa) nos segundos cinco, 10, 15 e 20. Os dados demográficos dos pacientes, estado físico ASA, IMC, nível de escolaridade, efeito das vias de injeção e local das cirurgias foram analisados quanto a seus efeitos no escore total de dor.RESULTADOS: Não houve diferença entre os grupos em relação ao escore total de dor (p = 0,981). Não houve diferença no escore total de dor em relação ao estado físico ASA, escolaridade e local da cirurgia. No entanto, lidocaína foi mais eficaz em comparação com metoprolol (p = 0,015) e nitroglicerina (p = 0,001), na comparação entre os grupos. Embora lidocaína e metoprolol não tenham apresentado diferença no tratamento da dor quando aplicados em veia antecubital ou do dorso da mão (p > 0,05), a injeção de nitroglicerina em veia antecubital apresentou escores de dor estatisticamente menores (p = 0,001).CONCLUSÃO: Lidocaína mostrou-se como analgésico mais eficaz para diminuir a dor relacionada à injeção de propofol. Sugerimos, portanto, lidocaína IV para aliviar a dor relacionada à injeção de propofol em operações.

[Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin]. / Lidocaína é mais eficaz do que metoprolol e nitroglicerina para o alívio da dor relacionada à injeção de propofol.

BACKGROUND AND OBJECTIVES: Injection pain after propofol administration is common and may disturb patients' comfort. The aim of this study was to compare effectiveness of intravenous (iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand or antecubital vein on eliminating propofol injection pain. METHOD: There were 147 patients and they were grouped according to the analgesic administered. Metoprolol (n=31, Group M), lidocaine (n=32, Group L) and nitroglycerin (n=29, Group N) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evaluated by 4 point scale (0 - no pain, 1 - light pain, 2 - mild pain, 3 - severe pain) in 5, 10, 15 and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathways for injection and location of operations were analyzed for their effect on total pain score. RESULTS: There were no differences between the groups in terms of total pain score (p=0.981). There were no differences in terms of total pain score depending on ASA, education level, location of operation. However, lidocaine was more effective when compared with metoprolol (p=0.015) and nitroglycerin (p=0.001) among groups. Although neither lidocaine nor metoprolol had any difference on pain management when applied from antecubital or dorsal hand vein (p>0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lower pain scores (p=0.001). CONCLUSION: We found lidocaine to be the most effective analgesic in decreasing propofol related pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.

Lidocaine alleviates propofol related pain much better than metoprolol and nitroglycerin.

BACKGROUND AND OBJECTIVES: Injection pain after propofol administration is common and may disturb patients' comfort. The aim of this study was to compare effectiveness of intravenous (iv) nitroglycerin, lidocaine and metoprolol applied through the veins on the dorsum of hand or antecubital vein on eliminating propofol injection pain. METHOD: There were 147 patients and they were grouped according to the analgesic administered. Metoprolol (n=31, Group M), lidocaine (n=32, Group L) and nitroglycerin (n=29, Group N) were applied through iv catheter at dorsum hand vein or antecubital vein. Pain was evaluated by 4 point scale (0 - no pain, 1 - light pain, 2 - mild pain, 3 - severe pain) in 5, 10, 15 and 20th seconds. ASA, BMI, patient demographics, education level and the effect of pathways for injection and location of operations were analyzed for their effect on total pain score. RESULTS: There were no differences between the groups in terms of total pain score (p=0.981). There were no differences in terms of total pain score depending on ASA, education level, location of operation. However, lidocaine was more effective when compared with metoprolol (p=0.015) and nitroglycerin (p=0.001) among groups. Although neither lidocaine nor metoprolol had any difference on pain management when applied from antecubital or dorsal hand vein (p>0.05), nitroglycerin injection from antecubital vein had demonstrated statistically lower pain scores (p=0.001). CONCLUSION: We found lidocaine to be the most effective analgesic in decreasing propofol related pain. We therefore suggest iv lidocaine for alleviating propofol related pain at operations.

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia.

STUDY OBJECTIVE: To compare the anesthetic effects of two different concentrations and doses of ropivacaine (0.2% and 0.25%) with those of a conventional dose of lidocaine 0.5%. DESIGN: Prospective, randomized, double-blinded, clinical investigation. SETTING: Large metropolitan university hospital. PATIENTS: 66 adult ASA physical status I and II patients undergoing forearm and hand surgery. INTERVENTIONS: Patients were randomly allocated to three groups to receive intravenous regional anesthesia (IVRA). Study groups were: ropivacaine 0.2% (Group I, n = 22), ropivacaine 0.25% (Group II, n = 22), and lidocaine 0.5% (Group III, n = 22). MEASUREMENTS: Tourniquet tolerance times and regression of sensory analgesia were noted. Verbal numerical pain scores (VNS), cumulative analgesic consumption, and side effects were recorded during surgery and postanesthesia care unit (PACU). Time to first pain medication intake and number of patients receiving analgesics in the PACU were recorded. MAIN RESULTS: Additional tolerance times for the distal tourniquet were significantly higher in the ropivacaine 0.25% group than the other two groups. Regression of sensory anesthesia was fastest in the lidocaine group. During the PACU stay, VNSs were significantly lower in the first 20 minutes in the ropivacaine groups than the lidocaine group. Time to first intake of pain medication in the PACU was soonest in the lidocaine group. The number of patients given analgesics in the PACU was highest in the lidocaine group. The number of patients taking > two tablets of tramadol was significantly lowest in the ropivacaine 0.25% group. No serious side effects were observed in any study group. CONCLUSION: Longer tolerance times for the distal tourniquet, prolonged analgesia after tourniquet release, and lower analgesic requirements postoperatively make ropivacaine 0.2% and 0.25% an alternative to lidocaine for IVRA.

The analgesic effect of 8 and 16 mg lornoxicam administered before shock wave lithotripsy: a randomized, double-blind, controlled study.

OBJECTIVES: To evaluate the efficacy of 2 different doses of intravenous lornoxicam for pain relief during shock wave lithotripsy (SWL). METHODS: In this randomized, controlled, double-blind study, 60 ASA I-II patients undergoing SWL were randomly divided into 3 groups. Fifteen minutes before SWL, 4 mL of saline solution was given to the patients in group I, 8 mg lornoxicam in group II, and 16 mg lornoxicam in group III. All groups received 1 mcg/kg fentanyl intravenously 3 minutes before SWL. Pain scores, blood pressure, heart rate, respiratory rate, and oxygen saturation were noted before SWL, at 1 minute and every 5 minutes during the procedure. Also, additional fentanyl consumption, oxygen support requirements, time for recovery room discharge, adverse effects, and patient satisfaction were recorded. RESULTS: The mean blood pressure, heart rate, and SpO(2) values were significantly lower in group I at 5 and 10 minutes (P < .01). The mean visual analogue scale scores and fentanyl consumption were higher in group I (P < .001). The additional meperidine requirement was higher in group I (P = .014). In group I, oxygen requirement was higher and recovery room period was longer than in the other 2 groups (P < .001), and 2 patients from group I had respiratory depression develop. The incidence of nausea and vomiting was higher in group I (P < .05). The patients' satisfaction scores were higher in groups II and III than in group I (P = .001). CONCLUSIONS: Eight milligrams of intravenously administered lornoxicam 15 minutes before SWL provides pain relief and patient satisfaction during the procedure, reducing opioid requirements as well as decreasing the incidence of side effects.