A comparison of metoclopramide and lidocaine for preventing pain on injection of diazepam

Effects of dezocine on prevention of propofol injection pain: a meta-analysis

Objective

The objective of this study was to evaluate the effects of dezocine on the prevention of propofol injection pain.

Materials and methods

We searched for randomized controlled trials (RCTs) of dezocine in preventing propofol injection pain, from inception to April 2016, in PubMed, Embase, Cochrane Library, and CNKI. Next, two reviewers independently screened literature, extracted data, and assessed quality in accordance with the inclusion and exclusion criteria. Finally, RevMan 5.2 software was used to conduct a meta-analysis.

Results

Seven RCTs totaling 630 patients were included in this meta-analysis. The meta-analysis study showed: 1) compared with the control group (relative risk [RR] =0.32, 95% CI [0.26, 0.39], P<0.00001), the dezocine group showed a decreasing incidence of propofol injection pain; 2) for severity of propofol injection pain, incidences of mild pain (RR =0.55, 95% CI [0.40, 0.75], P=0.0001), moderate pain (RR =0.28, 95% CI [0.18, 0.43], P<0.00001), and severe pain (RR =0.11, 95% CI [0.06, 0.23], P<0.00001) were considerably lower in the dezocine group than in the control group; 3) when comparing the incidence of propofol injection pain in the dezocine group with that of the lidocaine group, no statistically significant differences were found (RR =0.86, 95% CI [0.66, 1.13], P=0.29); and 4) subgroup analysis indicated a significant reduction in the incidence of propofol injection.

Conclusion

Dezocine can both prevent propofol injection pain and mitigate its severity, and its efficacy shows no significant difference from that of lidocaine.

Adding metoclopramide to lidocaine for intravenous regional anesthesia in trauma patients

Background:

Metoclopromide have local anesthetic properties. The main object of performing the present study was to evaluate the analgesic effect of metoclopromide 10 mg when added to lidocaine for intravenous regional anesthesia (IVRA) of upper extremities in trauma patients.

Materials and Methods:

Ninety patients undergoing upper limb producer were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (Group L, n = 30) or 10 mg metoclopromide plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml (group LM, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 ml plus 10 mg metoclopromide intravenously (Group IM, n = 30).

Results:

Our study showed that the onset times for sensory and motor block were significantly shorter in Group LM compared with Group L and Group IM (4.5 ± 0.7 vs. 5.0 ± 0.7 and 5.0 ± 0.6, respectively, P = 0.006 for sensory block; 6.3 ± 0.7 vs. 5.1 ± 0.9 and 5.9 ± 0.6 respectively, P = 0.000 for motor block). The postoperative VAS scores were significantly less at 1, 5, 10, 15, and 30 minutes after tourniquet release in Group LM compared with Group L and Group IM (P < 0.05).

Conclusion:

The results of our study showed that adding 10 mg metoclopromide to lidocaine for IVRG in trauma patients reduced intraoperative and postoperative analgesic use till 24 hours and improve quality of anesthesia.

Rapid injection of propofol reduces vascular pain and facilitates Laryngeal Mask Airway insertion

STUDY OBJECTIVE

To compare the clinical efficacy of a rapid injection of propofol in regard to pain and ability to facilitate Laryngeal Mask Airway (LMA) insertion.

DESIGN

Randomized, single-blinded, placebo-controlled study.

SETTING

University hospital.

PATIENTS

120 ASA physical status 1 and 2 patients undergoing elective orthopedic surgeries.

INTERVENTIONS

Patients were randomly allocated to one of 4 groups. Group A patients were pretreated with normal saline followed by propofol 2.0 mg/kg at 3.3 mg/sec. Group B patients were pretreated with lidocaine 0.5 mg/kg followed by propofol 2.0 mg/kg at 3.3 mg/sec. In Group C, patients were pretreated with lidocaine 1.0 mg/kg followed by propofol 2.0 mg/kg at 3.3 mg/sec. In Group D, patients were pretreated with normal saline followed by propofol 2.0 mg/kg at 50 mg/sec.

MEASUREMENTS

Pain on injection was measured using a 4-point scale. Scale and success rate of smooth LMA insertion also were recorded.

MAIN RESULTS

Rapid injection was less painful than after pretreatment with lidocaine 0.5 mg/kg, but was similar to slow injection after pretreatment with lidocaine 1.0 mg/kg. Rapid injection facilitated LMA insertion, unlike slow injection with lidocaine 0.5 mg/kg pretreatment, and was similarly successful to slow injection after pretreatment with lidocaine 1.0 mg/kg.

CONCLUSIONS

The rapid administration of propofol reduces pain and facilitates LMA insertion versus slow administration of propofol.

Chemical stability of tramadol hydrochloride injection admixed with selected pain drugs

BACKGROUND

Tramadol hydrochloride (HCl) and ketorolac tromethamine are analgesic drugs, which are commonly used in combination in postoperative pain management. According to some studies, metoclopramide and magnesium sulfate (MgSO(4)) as adjuvant agents can improve analgesia and decrease the need for other pain drugs.

MATERIALS AND METHODS

The chemical stability of tramadol HCl combined with ketorolac tromethamine and metoclopramide HCl has been studied using a stability-indicating high-performance liquid chromatographic assay method. Calibration curves were produced using linear regression of the peak area against concentration of each drug, with an r(2) value ≥ 0.96. Our aim was to investigate the stability of admixture solution of tramadol HCl combined with ketorolac tromethamine and metoclopramide HCl for 48 h (25°C) and 5 days (5°C), with MgSO(4), which has never been assessed.

RESULTS

Data obtained for admixtures prepared and stored at temperatures of 25°C and 5°C, show that all drugs have reached at least 98% of the initial concentration.

CONCLUSIONS

For the purpose of pre-preparing drug admixtures to use with confidence, tramadol HCl infusions may be prepared in advance and then thawed before use in clinical units. On the basis of our results, the intravenous mixture of tramadol (7.69 mg/mL), metoclopramide (0.19 mg/mL), ketorolac (1.15 mg/mL), and magnesium sulfate (77 mg/mL) may be considered for a possible commercial formulation.

Long-term stability of tramadol chlorhydrate and metoclopramide hydrochloride in dextrose 5% polyolefin bag at 4°C

Objectives. Preparation of intravenous solution in advance could be efficient to improve quality assurance, security, time management, and cost saving of drug delivery. The purpose of this study was to investigate the stability of a mixture of tramadol chlorhydrate and metoclopramide hydrochloride in dextrose 5% polyolefin bags at 4°C.

Methods. The stability of five bags of solution containing 100 mg tramadol and 10 mg metoclopramide per 100 mL dextrose 5% and stored at 4°C was studied during 32 days and concentrations measured by high performance liquid chromatography-diode array detection.

Results. No degradation interference nor modification in retention times were observed throughout the study period. At day 32, tramadol concentration was 96.9% ± 2.1 and metoclopramide 97.2% ± 1.3 of the initial concentration.

Conclusion. Based on a shelf-life of 90% residual potency, tramadol and metoclopramide were compatible and stable for at least 32 days at 4°C and can be prepared in advance in a centralized intravenous additive service facility. J Oncol Pharm Practice (2009) 15: 195—200.