Comparison of Intravenous Retention of Fentanyl and Lidocaine on Local Analgesia in Propofol Injection Pain

比較靜脈內存留Fentanyl與Lidocaine能減少Propofol注射引起疼痛的效果

龐維伍(Wei-Wu Pang) ； 黃玄(Shyuan Huang) ； 鍾雍泰(Yung-Tai Chung) ； 張大鵬(Da-Peng Chang) ； 林世祥(Shi-Shiang Lin) ； 黃明和(Min-Ho Hong)

《Acta Anaesthesiologica Sinica》 35卷4期 (1997/12) Pp. 217-221

摘要

Background: With a tourniquet on arm for arresting venous blood flow, we evaluated the efficacy of intravenous (IV) retention of fentanyl and lidocaine in reducing the pain on IV propofol injection during general anesthesia. Methods: One hundred and twelve patients were studied. Following a venous occlusion by a tourniquet inflated to 70 mm Hg，patients in Group A (n=38) received normal saline (NS) 3 ml, while those in Group B (n=37) and in Group C (n=37) respectively received fentanyl 150pg or 3 ml and 2% lidocaine 3 ml (60mg). The venous retention of drug was maintained for 1 min, followed immediately by tourniquet release and propofol 100 mg IV injection over 20 s. Results: Both fentanyl and lidocaine treatments (Groups B and C) were significantly better than placebo (Group A) in reducing pain on propofol injection (p＜0.005). Lidocaine 60 mg was more effective than fentanyl 150 μg in reduction of pain associated with IV propofol (p ＜0.001). Injection of fentanyl itself caused pain in 28% of patients as compared to 2% in the lidocaine group. Mild local skin erythema was noted in 14% of patients with fentanyl venous retention versus 0% of patients with lidocaine venous retention. Conclusions: Intravenous retention of fentanyl 150 μg, although less effective than that of lidocaine (p＜0.001), showed local analgesic effect in reducing the pain on propofol injection. The hypothetic mechanisms of action were speculated.

關鍵字

Anesthetics, intravenous: propofol ； Anesthetics, local: lidocaine ； Analgesics, opioid: fentanyl ； Pain: injection, intravenous

並列摘要

背景：靜脈內存留lidocaine 60毫克有效地防止propofol之注射痛，但fentanyl對此種週邊之作用尚未比較過。方法：112位麻醉體位1和2之病患分成三組，在上臂綁上靜脈止血帶後：A組（n＝38）靜脈注入生理鹽水3西西，B組（n＝37）注入fentanyl 3西西，C組（n＝37）組注入2% lidocaine 3西西，在一分鐘後放開止血帶，開始以propofol 100毫克引導麻醉。結果：在B和C組之病患都比A組較少有propofol之注射痛（p＜0.005）。Lidocaine 60毫克之效果最好，fentanyl 3西西or 150 μg雖然較xylocaine為差，但Fentanyl 3西西也有較生理鹽水強之效果（p＜0.005）。Fentanyl靜脈內存留之副作用包括28%病患有短暫（一分鐘內）之注射痛及14%病患有暫時性（兩小時內）輕微之局部皮膚發紅。Lidocaine只有2%病患有短暫（一分鐘內）之注射痛而無其他之副作用。結論：在靜脈內存留一分鐘，fentanyl 3西西之止痛作用較2% lidocaine 3西西為差，亦有較多的副作用，本文對fentanyl之局部止痛作用加以探討。

並列關鍵字

麻醉劑，靜脈內：propofol ； 麻醉劑，局部性：lidocaine ； 止痛劑，類鴉片製劑：fentanyI ； 疼痛：靜脈注射