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Akhtar SMM, Fareed A, Ali M, Khan MS, Ali A, Mumtaz M, Kirchoff R, Asghar MS. Efficacy and safety of Ciprofol compared with Propofol during general anesthesia induction: A systematic review and meta-analysis of randomized controlled trials (RCT). J Clin Anesth 2024; 94:111425. [PMID: 38412619 DOI: 10.1016/j.jclinane.2024.111425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Ciprofol, a newer entrant with similarities to propofol, has shown promise with a potentially improved safety profile, making it an attractive alternative for induction of general anesthesia. This meta-analysis aimed to assess the safety and efficacy of ciprofol compared with propofol during general anesthesia induction. METHODS A comprehensive literature search was conducted using PubMed, Clinical Trial.gov, and Cochrane Library databases from inception to July 2023 to identify relevant studies. All statistical analyses were conducted using R statistical software version 4.1.2. RESULTS Thirteen Randomized Controlled Trials (RCTs) encompassing a total of 1998 participants, were included in our analysis. The pooled analysis indicated that Ciprofol was associated with a notably lower incidence of pain upon injection [RR: 0.15; 95% CI: 0.10 to 0.23; I^2 = 43%, p < 0.0000001] and was non-inferior to propofol in terms of anesthesia success rate [RR: 1.00; 95% CI: 0.99 to 1.01; I^2 = 0%; p = 0.43]. In terms of safety, the incidence of hypotension was significantly lower in the ciprofol group [RR:0.82; 95% CI:0.68 to 0.98; I^2 = 48%; p = 0.03]. However, no statistically significant differences were found for postoperative hypertension, bradycardia, or tachycardia. CONCLUSION In conclusion, Ciprofol is not inferior to Propofol in terms of its effectiveness in general anesthesia. Ciprofol emerges as a valuable alternative sedative with fewer side effects, especially reduced injection pain, when compared to Propofol. SUMMARY Propofol, frequently utilized as an anesthetic, provides swift onset and quick recovery. However, it has drawbacks such as a narrow effective dosage range and a high occurrence of adverse effects, particularly pain upon injection. Ciprofol, a more recent drug with propofol-like properties, has demonstrated promise and may have an improved safety profile, making it a compelling alternative for inducing general anesthesia. This meta-analysis compared the safety and effectiveness of Ciprofol with Propofol for general anesthesia induction in a range of medical procedures, encompassing thirteen Randomized Controlled Trials (RCTs) and 1998 individuals. The pooled analysis indicated that Ciprofol was associated with a notably lower incidence of pain upon injection [RR: 0.15; 95% CI: 0.10 to 0.23; I^2 = 43%, p < 0.0000001] and was non-inferior to propofol in terms of anesthesia success rate [RR: 1.00; 95% CI: 0.99 to 1.01; I^2 = 0%; p = 0.43]. In terms of safety, the incidence of hypotension was significantly lower in the ciprofol group [RR:0.82; 95% CI:0.68 to 0.98; I^2 = 48%; p = 0.03]. However, no statistically significant differences were found for hypertension, bradycardia, or tachycardia. In conclusion, ciprofol is equally effective at inducing and maintaining general anesthesia as propofol. When compared to propofol, ciprofol is a better alternative sedative for operations including fiberoptic bronchoscopy, gynecological procedures, gastrointestinal endoscopic procedures, and elective surgeries because it has less adverse effects, most notably less painful injections.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Mirha Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan
| | - Robert Kirchoff
- Department of Medicine, Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA.
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Mathias N, Huille S, Picci M, Mahoney RP, Pettis RJ, Case B, Helk B, Kang D, Shah R, Ma J, Bhattacharya D, Krishnamachari Y, Doucet D, Maksimovikj N, Babaee S, Garidel P, Esfandiary R, Gandhi R. Towards more tolerable subcutaneous administration: Review of contributing factors for improving combination product design. Adv Drug Deliv Rev 2024; 209:115301. [PMID: 38570141 DOI: 10.1016/j.addr.2024.115301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
Subcutaneous (SC) injections can be associated with local pain and discomfort that is subjective and may affect treatment adherence and overall patient experience. With innovations increasingly focused on finding ways to deliver higher doses and volumes (≥2 mL), there is a need to better understand the multiple intertwined factors that influence pain upon SC injection. As a priority for the SC Drug Development & Delivery Consortium, this manuscript provides a comprehensive review of known attributes from published literature that contribute to pain/discomfort upon SC injection from three perspectives: (1) device and delivery factors that cause physical pain, (2) formulation factors that trigger pain responses, and (3) human factors impacting pain perception. Leveraging the Consortium's collective expertise, we provide an assessment of the comparative and interdependent factors likely to impact SC injection pain. In addition, we offer expert insights and future perspectives to fill identified gaps in knowledge to help advance the development of patient-centric and well tolerated high-dose/high-volume SC drug delivery solutions.
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Affiliation(s)
- Neil Mathias
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Sylvain Huille
- Sanofi, 13 quai Jules Guesde, 94400 Vitry-Sur-Seine, France.
| | - Marie Picci
- Novartis Pharma AG, Fabrikstrasse 4, CH-4056 Basel, Switzerland
| | - Robert P Mahoney
- Comera Life Sciences, 12 Gill St, Suite 4650, Woburn, MA 01801 USA
| | - Ronald J Pettis
- Becton-Dickinson, 21 Davis Drive, Research Triangle Park, NC 27513 USA
| | - Brian Case
- KORU Medical Systems, 100 Corporate Dr, Mahwah, NJ 07430 USA
| | - Bernhard Helk
- Novartis Pharma AG, Werk Klybeck, WKL-681.4.42, CH-4057 Basel, Switzerland
| | - David Kang
- Halozyme Therapeutics, Inc., 12390 El Camino Real, San Diego, CA 92130 USA
| | - Ronak Shah
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
| | - Junchi Ma
- Johnson & Johnson Innovative Medicine, 200 Great Valley Pkwy, Malvern, PA 19355 USA
| | | | | | - Dany Doucet
- GSK, 1250 South Collegeville Road, Collegeville, PA 19426 USA
| | | | - Sahab Babaee
- Merck & Co., Inc., 126 E. Lincoln Ave., Rahway, NJ 07065 USA
| | - Patrick Garidel
- Boehringer Ingelheim Pharma GmbH & Co. KG, Birkendorfer Straße 65, 88397 Biberach/Riss, Germany
| | | | - Rajesh Gandhi
- Bristol-Myers Squibb, Co., 1 Squibb Dr, New Brunswick, NJ, 08901 USA
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Athadeu AMS, Câmara-Souza MB, Poluha RL, Soares VWHA, de Souza Nobre BB, Manso C, de Almeida AM, De la Torre Canales G. Comparison of the Effectiveness of Different Methods for Pain Reduction During Injection Procedures in the Frontalis Muscle. Aesthetic Plast Surg 2024; 48:999-1004. [PMID: 37202480 DOI: 10.1007/s00266-023-03399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Forehead aesthetic injections are a well-known source of discomfort, and many analgesic non-invasive techniques have been proposed to ameliorate pain. However, no study has compared all these techniques for aesthetic purposes. Therefore, this study aimed to compare the effectiveness of topical cream anesthesia, vibratory stimulus, cryotherapy, pressure, and even no intervention, on pain during and immediately after injection, when considering aesthetic injections in the forehead. METHODS Seventy patients were selected and had their foreheads divided into 5 parts, which received four different analgesic techniques, and one control zone was added. A numeric rating scale was used to assess pain, two direct questions were asked to evaluate patients' preference and discomfort with the techniques, and the adverse events were quantified. The injections were performed in the same sequence, with three minutes of rest between them and in a single session. Comparisons among analgesic methods for pain relief were performed by the one-way analysis of variance (ANOVA), considering a significance level of 5%. RESULTS No significant differences were found among the analgesic methods, and between the methods and the control zone, both during and immediately after the injections (p > 0.05). The preferred method for pain relief was the use of topical anesthetic cream (47%), while the most uncomfortable technique was manual distraction (pressure) (36%). Only one patient reported an adverse event. CONCLUSIONS No analgesic method to diminish pain was superior to the others or was better than no method. Nevertheless, the topical anesthetic cream was the preferred technique, causing less discomfort. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | | | | | | | | | - Cristina Manso
- Clinical Research Unit (CRU) - Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, Cooperativa de Ensino Superior, CRL, Egas Moniz School of Health & Science, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal
| | - André Mariz de Almeida
- Clinical Research Unit (CRU) - Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, Cooperativa de Ensino Superior, CRL, Egas Moniz School of Health & Science, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal
| | - Giancarlo De la Torre Canales
- Ingá University Center, Uningá, Maringá, Paraná, Brazil.
- Clinical Research Unit (CRU) - Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, Cooperativa de Ensino Superior, CRL, Egas Moniz School of Health & Science, Quinta da Granja, Monte de Caparica, Caparica, 2829-511, Portugal.
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Joo CW, Song WS, Lee MJ, Choi YJ. Insulin syringe for anesthesia in ptosis surgery: a randomized, fellow eye-controlled clinical study. Int Ophthalmol 2023; 43:2721-2730. [PMID: 36869981 DOI: 10.1007/s10792-023-02671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Unlike ordinary 30-gauge needles, insulin syringe needles are thinner and shorter and have a comparatively blunt tip. Therefore, insulin syringes may reduce injection discomfort, bleeding, and edema by minimizing tissue damage and vascular penetration. This study aimed to evaluate the potential benefits of using insulin syringes for local anesthesia in ptosis surgery. METHODS This randomized, fellow eye-controlled study included 60 patients (120 eyelids), conducted at a university-based hospital. An insulin syringe was used on one eyelid, and a conventional 30-gauge needle was used on the other. Patients were instructed to score pain in both eyelids using a visual analog scale (VAS) ranging from 0 (no pain) to 10 (unbearable pain). Ten minutes after the injection, two observers scored degrees of hemorrhage and edema in both eyelids on five- and four-pointing grading scales (0-4 and 0-3) for each value, and the average score between the two observers was calculated and compared. RESULTS The VAS score was 5.17 in the insulin syringe group and 5.35 in the 30-gauge needle group (p = 0.282). Ten minutes after the anesthesia, the median hemorrhage scores were 1.00 and 1.75 (p = 0.010), and the median eyelid edema scores were 1.25 and 2.00 (p = 0.007) in the insulin syringe and 30-gauge needle groups, respectively (Fig. 1). CONCLUSION Injecting local anesthesia using an insulin syringe significantly reduces hemorrhage and eyelid edema, but not injection pain, before skin incision. Insulin syringes are useful in patients at high risk of bleeding because they can reduce the penetrative tissue damage caused by needle insertion.
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Affiliation(s)
- Chan Woong Joo
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Won Seok Song
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Min Joung Lee
- Department of Ophthalmology, Hallym Sacred Heart Hospital, Anyang, Korea
- Department of Ophthalmology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Youn Joo Choi
- Department of Ophthalmology, Kangdong Sacred Heart Hospital, Seoul, Korea.
- Department of Ophthalmology, College of Medicine, Hallym University, Chuncheon, Korea.
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Elbay M, Elbay ÜŞ, Kaya E, Kalkan ÖP. Effects of photobiomodulation with different application parameters on injection pain in children: a randomized clinical trial. J Clin Pediatr Dent 2023; 47:54-62. [PMID: 37408347 DOI: 10.22514/jocpd.2023.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/28/2023] [Indexed: 07/07/2023] Open
Abstract
Photobiomodulation (PBM) has gained increasing interest due to its effectiveness in pain reduction in various fields of dentistry. However, the number of studies evaluating the effect of PBM on injection pain in children is very limited. The aim of the study was to evaluate the efficacy of PBM with three different application parameters (doses) + topical anesthesia on reducing injection pain and to compare these results with the placebo PBM + topical anesthesia in children during supraperiosteal anesthesia administration. 160 children were randomly divided into 4 groups, 3 experimental and 1 control, with 40 subjects in each. In the experimental groups, before the anesthesia administration, PBM with a power of 0.3 W was applied for 20, 30 and 40 s in groups 1, 2 and 3, respectively. In group 4, a placebo application of laser was performed. The pain felt during the injection was assessed using the Wong-Baker Faces Pain Rating Scale (PRS), and also the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Statistical analyses were performed to evaluate the data (p < 0.05). The mean FLACC Scale pain scores were 3.02 ± 2.93, 2.92 ± 2.54, 2.12 ± 1.89 and 1.77 ± 1.90 for the placebo group, and Groups 1, 2, and 3, respectively. Furthermore, the mean PRS scores were 1 ± 1.03, 0.95 ± 0.98, 0.80 ± 0.822 and 0.65 ± 0.921 for the placebo group, and Groups 1, 2 and 3, respectively. The "no pain response" rate was higher in Group 3 as compared to Groups 1, 2, and placebo according to the FLACC Scale and PRS; however, no difference was found between the groups (p = 0.109, p = 0.317). Injection pain in children did not differ with placebo and PBM applied with a power of 0.3 W for 20, 30 and 40 s.
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Affiliation(s)
- Mesut Elbay
- Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, 41190 Kocaeli, Turkey
| | - Ülkü Şermet Elbay
- Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, 41190 Kocaeli, Turkey
| | - Emine Kaya
- Department of Pediatric Dentistry, Faculty of Dentistry, Okan University, 34959 İstanbul, Turkey
| | - Özlem Peyman Kalkan
- Department of Pediatric Dentistry, Faculty of Dentistry, Kocaeli University, 41190 Kocaeli, Turkey
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Yan S, Wu H, Yu Y, Li N, Yu L, Wang Y, Li H, Zhang D, Zhang Z. Median Effective Dose of Remifentanil for the Prevention of Pain Caused by the Injection of Rocuronium: An Age-Stratified Study. Pain Ther 2023; 12:683-694. [PMID: 36884108 PMCID: PMC10199981 DOI: 10.1007/s40122-023-00490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Rocuronium intravenous pain is common in induction of general anesthesia. The aim of our study was to determine the median effective dose (ED50) of prophylactic intravenous remifentanil for the prevention of rocuronium injection pain and to explore the effect of age on the ED50. METHODS Eighty-nine adult patients undergoing elective general anesthesia, ASA I or II, regardless of gender or weight, were stratified according to age: group R1 18-44 years, group R2 45-59 years, and group R3 60-80 years. The initial dose of prophylactic remifentanil before rocuronium injection was set at 1 μg/kg lean body weight (LBW). The remifentanil doses were adjusted according to the degree of injection pain using the Dixon sequential method, with a ratio of 1.1 between adjacent doses. Injection pain was graded, and the occurrence of injection pain and adverse reactions were recorded. The ED50 and 95% confidence intervals (CIs) of remifentanil were calculated using the Dixon-Massey formula. Patients were asked whether they recalled feeling any injection pain in the post-anesthesia care unit (PACU). RESULTS The ED50 (95% CIs) of prophylactic remifentanil for the prevention of rocuronium injection pain were 1.266 μg/kg (1.186-1.351 μg/kg), 1.188 μg/kg (1.065-1.324 μg/kg), and 1.070 μg/kg (1.014-1.129 μg/kg) LBW in group R1, group R2, and group R3, respectively. No adverse reactions to remifentanil occurred in any group. In PACU, 84.6, 86.7, and 85.7% of patients who experienced injection pain had memories of the pain in group R1, group R2, and group R3, respectively. CONCLUSIONS Prophylactic intravenous remifentanil can prevent rocuronium injection pain, and its ED50 decreases with age, with 1.266 μg/kg (18-44 years), 1.188 μg/kg (45-59 years), and 1.070 μg/kg LBW (60-80 years), respectively. TRIAL REGISTRATION ClinicalTrials.gov: NCT05217238 (registration date 18 Dec 2021).
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Affiliation(s)
- Shiting Yan
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- Graduate School, Dalian Medical University, lushun 9 western south road, Dalian, 116000, Liaoning, China
| | - Hao Wu
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- School of Medicine, Yangzhou University, 136 Jiang Yang Middle Road, Yangzhou, 225009, Jiangsu, China
| | - Yanlong Yu
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- School of Medicine, Yangzhou University, 136 Jiang Yang Middle Road, Yangzhou, 225009, Jiangsu, China
| | - Ning Li
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- School of Medicine, Yangzhou University, 136 Jiang Yang Middle Road, Yangzhou, 225009, Jiangsu, China
| | - Leyang Yu
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- Graduate School, Dalian Medical University, lushun 9 western south road, Dalian, 116000, Liaoning, China
| | - Ying Wang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- Graduate School, Dalian Medical University, lushun 9 western south road, Dalian, 116000, Liaoning, China
| | - Hu Li
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
- Graduate School, Dalian Medical University, lushun 9 western south road, Dalian, 116000, Liaoning, China
| | - Dongsheng Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China
| | - Zhuan Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 368 Hanjiang Middle Road, Yangzhou, 225012, Jiangsu, China.
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Foreman-Hesterberg CR, Foreman JH. Plasma Creatine Kinase and Aspartate Aminotransferase Activities Before, During, and After 5 Days of Intramuscular Penicillin Administration in Sedentary Horses. J Equine Vet Sci 2023; 122:104231. [PMID: 36736501 DOI: 10.1016/j.jevs.2023.104231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/20/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
Muscle damage can result in leakage of intracellular enzymes such as creatine kinase (CK) and aspartate transaminase (AST) into plasma. There are no controlled documentations of the effects of intramuscular antibiotic drug administration on plasma CK and AST activities in horses. The objective of this experiment was to test the hypothesis that 5 days of intramuscular procaine penicillin G injection in normal horses would result in increased plasma activities of CK and AST. Nine healthy adult horses were sampled for 7 days preceding, 5 days during, and 32 days following procaine penicillin G (22,000 IU/kg) administration intramuscularly twice daily. Heparinized jugular venous blood samples were obtained daily before treatment and were analyzed the same day for plasma activities of CK and AST. Repeated measures ANOVA and post hoc Tukey's Test were used to identify days where CK or AST were elevated compared to control means at a significance level of P < .05. Beginning the day after first injection, plasma CK increased above the reference range, peaking at 2,046 ± 627 U/L after 3 days, and returned to 227 ± 57.3 U/L (within the reference range) 9 days after treatment began. Beginning the day after first injection, plasma AST increased, peaking at 703 ± 135 U/L on the day after the last injection. Plasma AST did not return to the reference range in all individual horses until 29 days after the last injection (mean 247 ± 33 U/L). Compared to the control period, plasma CK and AST elevations lasted for 8 and 28 days, respectively, after the onset of treatment (P < .001 to P = .03) and lasted for 4 and 24 days, respectively, after the last day of treatment (P < .001 to P = .03).
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Affiliation(s)
- Catherine R Foreman-Hesterberg
- College of Veterinary Medicine, Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Jonathan H Foreman
- College of Veterinary Medicine, Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL.
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Liu HM, Wu TJ, Liou CM, Chiu WK, Kang YN, Chen C. Patient Comfort with Various Local Infiltration Anesthetics for Minor Oculoplastic Surgery: A Systematic Review and Network Meta-Analysis. J Plast Reconstr Aesthet Surg 2022; 75:3473-3484. [PMID: 35961926 DOI: 10.1016/j.bjps.2022.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although local anesthetics have been extensively studied, limited evidence is available regarding the optimal solution for maximizing patient comfort in minor oculoplastic procedures. OBJECTIVES To determine the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries to maximize patient comfort. METHODS This systematic review with network meta-analysis of prospective studies was conducted to understand the efficacy of different local anesthetics in combination to maximize patient comfort. The study was designed according to the Cochrane Handbook for Systematic Reviews of Interventions. The population comprised patients receiving local infiltration anesthesia in minor oculoplastic surgeries. Various anesthetics with adjuvants were compared with respect to injection pain, operative bleeding, and complications. Random-effects model was performed. The primary outcome of injection pain was measured using the visual analog scale (VAS) or a preference question (which intervention was the least painful). Other outcomes were operative bleeding and complications, which were evaluated with a similar preference question. RESULTS Eleven randomized controlled trials (RCTs) of 521 patients (917 eyes) were included. The network meta-analysis revealed that "bicarbonate-buffered lidocaine with epinephrine" led to a significant decrease in injection pain (preference question) compared to "prilocaine with felypressin" and "lidocaine with epinephrine," whereas no significant differences were detected in the analysis of injection pain measured using the VAS. CONCLUSIONS "Bicarbonate-buffered lidocaine with epinephrine" may be the optimal anesthetic solution for local infiltration in minor oculoplastic surgeries due to reduced injection pain, operative bleeding, and postoperative swelling. However, this should be interpreted cautiously as the confidence in the evidence was very low. THE CLINICAL TRIAL REGISTRATION NUMBER CRD42021260332 (PROSPERO).
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Affiliation(s)
- Hsin-Ming Liu
- Department of Ophthalmology, Mackay Memorial Hospital, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
| | - Cher-Ming Liou
- Department of Anesthesiology, Chung Shan Medical University Hospital, Chung Shan Medical University; Institute of Medicine, Chung Shan Medical University, Taichung City, Taiwan
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Yi-No Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan; Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
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Wasinwong W, Termthong S, Plansangkate P, Tanasansuttiporn J, Kosem R, Chaofan S. A comparison of ondansetron and lidocaine in reducing injection pain of propofol: a randomized controlled study. BMC Anesthesiol 2022; 22:109. [PMID: 35436859 DOI: 10.1186/s12871-022-01650-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 04/08/2022] [Indexed: 12/13/2022] Open
Abstract
Background Direct stimulation of the afferent nerve endings in the venous endothelium is one explanation of propofol injection pain. Previous studies found that ondansetron can also block sodium channels. This effect is similar to that of lidocaine. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18–65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg. of ondansetron in the O Group, 40 mg. of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly administered to the patients through a 20-gauge intravenous catheter placed on the hand dorsum, and then 1 min later, the small dose of propofol (50 mg.) was infused via the syringe pump at a rate of 600 ml/hr. for 30 s. Following that, the syringe pump of propofol was temporarily stopped, and the patients were asked to rate their pain at the injection site. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P < 0.01). The median pain score in the L, O, and C groups were 2 (0–4), 4 (2–5), and 4.5 (2–6), respectively (P < 0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P < 0.01). Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.
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Crump B, Reader A, Nusstein J, Drum M, Fowler S, Draper J. Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain. Anesth Prog 2022; 69:10-17. [PMID: 35377934 DOI: 10.2344/anpr-68-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/04/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain. METHODS A total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS). RESULTS The combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively. CONCLUSION Providing PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.
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Affiliation(s)
- Brian Crump
- Former Graduate Student in Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Draper
- Assistant Professor, Fisher College of Business, The Ohio State University, Columbus, Ohio
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11
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Kushnir B, Fowler S, Drum M, Nusstein J, Reader A, Dds MB. Nitrous Oxide/Oxygen Effect on IANB Injection Pain and Mandibular Pulpal Anesthesia in Asymptomatic Subjects. Anesth Prog 2021; 68:69-75. [PMID: 34185865 DOI: 10.2344/anpr-68-01-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022] Open
Abstract
The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N2O/O2) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N2O/O2 or room air/oxygen (air/O2) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N2O/O2 was used compared with Air/O2 (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N2O/O2 group compared with the air/O2 group. N2O/O2 administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.
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Affiliation(s)
- Ben Kushnir
- Former Graduate Student in Endodontics, The Ohio State University, Columbus, Ohio.,Private practice, Columbus, Ohio
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Mike Beck Dds
- Emeritus Associate Professor, Division of Biosciences, The Ohio State University, Columbus, Ohio
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12
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Christensen C, Arnason SC, Oates R, Crabtree M, Kersey JW, Vandewalle KS. Efficacy of Pulpal Anesthesia Using a Needle-less Syringe. Anesth Prog 2021; 67:200-206. [PMID: 33393602 DOI: 10.2344/anpr-67-02-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 04/20/2020] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to investigate the manufacturer's claims regarding a novel needleless intraligamentary local anesthesia injection device (Numbee, BioDent) to provide effective single tooth anesthesia. Investigators compared the Numbee with a traditional inferior alveolar nerve block (IANB) during a restorative procedure on mandibular teeth. A randomized, split-mouth design was conducted with 15 adult subjects receiving an IANB on one side and a Numbee injection on the same tooth type on the contralateral side. Subjects recorded injection pain using the Visual Analog Scale (VAS) and their preferred injection technique. Anesthesia was considered profound with 2 consecutive electric pulp tester readings of 80. If subjects became symptomatic during the restorative procedure, rescue anesthesia was administered. The difference in VAS scores for injection pain between the Numbee and the IANB was not significant (p = .078). For the IANB, the incidence of profound anesthesia was 46%, and required rescue anesthesia was 20%. For the Numbee, the incidence of profound anesthesia was 0%, and required rescue anesthesia was 60%. Subject preference was evenly split (50/50%) between the 2 techniques. The IANB outperformed the Numbee device for achieving profound anesthesia and requiring less rescue anesthesia.
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Affiliation(s)
| | - Stephen C Arnason
- Maj, USAF, DC, Training Officer, Advanced Education in General Dentistry Residency, Joint Base San Antonio-Lackland, Texas
| | - Ross Oates
- Maj, USAF, DC, General Dentist, Eglin AFB, Florida
| | - Michael Crabtree
- Col, USAF, DC, Director, Endodontics, Advanced Education in General Dentistry Residency, Joint Base San Antonio-Lackland, Texas
| | - John W Kersey
- Col, USAF, DC, Director, Pediatric Dentistry, Advanced Education in General Dentistry Residency, Joint Base San Antonio-Lackland, Texas
| | - Kraig S Vandewalle
- Col (ret), USAF, DC, Director of Dental Research, Advanced Education in General Dentistry Residency, Joint Base San Antonio-Lackland, Texas
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13
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Hamada K, Takahashi K, Tokinaga Y, Iwasaki S, Yamakage M. Generic rocuronium reduces withdrawal movements compared to original rocuronium under target-controlled infusion induction with propofol. J Anesth 2021; 35:184-8. [PMID: 33420819 DOI: 10.1007/s00540-020-02889-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Rocuronium-induced injection pain often causes withdrawal movements leading to accidental disruption of indwelling needles. Generic rocuronium (Maruishi Pharmaceutical Co., Ltd, Osaka, Japan) with a novel solution has been reported to reduce the injection pain compared to original rocuronium [Esmeron® (Eslax®), MSD Co. Ltd, Tokyo, Japan], however, no reports have compared the injection pain under sedation with propofol, the most frequently used general anesthetic. This study was carried out to compare the injection pain caused by generic rocuronium and that caused by original rocuronium in patients anesthetized by propofol with a target-controlled infusion system. METHODS Forty patients were randomly assigned to two groups in this single-center, prospective, randomized, double-blind study. One group was administered generic rocuronium after sedation with propofol with a target-controlled infusion system. The other group was administered original rocuronium after anesthesia with propofol. Patient's withdrawal movements were assessed with the scale. The primary outcome was the total incidence of movement after administration of rocuronium. Secondary outcome was the incidence of moderate or severe movement after administration of rocuronium. RESULTS The total incidence of movement after administration of generic rocuronium (11%) was significantly lower than that after the administration of original rocuronium (79%) (p < 0.01). The incidence of moderate or severe movement after administration of generic rocuronium (0%) was significantly lower than that after the administration of original rocuronium (53%) (p < 0.01). CONCLUSION Generic rocuronium was considered more suitable than the original rocuronium for induction of anesthesia by propofol performed with a target-controlled infusion system.
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14
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Yıldırım S, Tokuç M, Aydın MN. The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial. Clin Oral Investig 2020; 24:4355-61. [PMID: 32382924 DOI: 10.1007/s00784-020-03301-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of pain control between a needle-free system and topical anesthesia applied prior to inferior alveolar nerve block (IANB). MATERIALS AND METHODS The present study was designed as a randomized controlled cross-over clinical study on 60 children (aged 6 to 12 years) requiring dental treatment with IANB in bilateral mandibular molars. As pre-anesthesia, topical anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions before IANB. The injection pain during IANB, at both the needle insertion and solution deposition phases, was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). The data were analyzed using the Wilcoxon signed-rank test, Spearman correlation, and Mann-Whitney U test. RESULTS There were statistically significant differences between TA and CIS in subjective and objective pain evaluations during both the needle insertion and solution deposition. The use of a needle-free system in pre-anesthesia yielded a significant decrease in subjective and objective pain scores (p < 0.001). No statistical difference was found between TA and CIS in terms of patient preference, but patient preference for CIS was significantly higher in older patients (p < 0.01). CONCLUSIONS It was determined that the use of a needle-free system in pre-anesthesia yielded a decrease in injection pain of IANB. CLINICAL RELEVANCE Pediatric dentists should be aware of the new injection system in order to decrease the level of injection pain.
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15
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Wang J, Cui Y, Liu B, Chen J. The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis. BMC Anesthesiol 2020; 20:89. [PMID: 32312228 PMCID: PMC7171835 DOI: 10.1186/s12871-020-00990-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
Background Rocuronium-associated injection pain/withdrawal response (RAIPWR) was non-ideal but occurred frequently when injection intravenously during anesthesia induction. Many studies had reported that pretreating with antipyretic analgesics (AAs) could reduce the occurrence of RAIPWR, but there was no consensus yet. Therefore, this meta-analysis was designed to systematically evaluate the benefits of AAs on RAIPWR in patients. Methods PubMed, Cochrane Library, Ovid, EMbase, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Data were searched by January 1st 2019 for randomized controlled trials (RCTs) applying AAs to alleviate RAIPWR in patients who underwent elective surgery under general anesthesia. Two investigators assessed quality of RCTs and extracted data respectively and the meta-analysis was carried on Revman 5.3 software. Moreover, we compared AAs in pros and cons directly with lidocaine, the most reported medicine to prevent RAIPWR. Results Data were analyzed from 9 RCTs totaling 819 patients. The results of Meta-analysis showed that compared to the control group, pretreating with AAs could prevent the total occurrence of RAIPWR [Risk ratio (RR), 0.52; 95% confidence interval (CI), 0.42 to 0.66; P < 0.0001], and took effect on moderate (RR, 0.56; 95%CI, 0.43 to 0.73; P < 0.0001) and severe RAIPWR (RR = 0.14; 95%CI, 0.08 to 0.24; P < 0.00001). When compared to lidocaine, the preventive effect was not so excellent as the latter but injection pain induced by prophylactic occurred less. Conclusion The currently available evidence suggested that pretreating with AAs intravenously could alleviate RAIPWR. Trial registration PROSPERO CRD42019129776.
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Affiliation(s)
- Jia Wang
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China
| | - Yu Cui
- Chengdu Women's & Children's Central Hospital, Chengdu, 610000, P.R. China
| | - Bin Liu
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China.
| | - Jianfeng Chen
- West China Hospital of Sichuan University, No. 37th, Guoxue Lane, Wuhou District, Chengdu City, Sichuan Province, P.R. China
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16
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Watanabe F, Kako H, Miyazu M. Comparison of injection pain in pediatric population; original versus generic rocuronium. Saudi J Anaesth 2020; 14:44-47. [PMID: 31998019 PMCID: PMC6970383 DOI: 10.4103/sja.sja_338_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/25/2019] [Accepted: 08/24/2019] [Indexed: 11/04/2022] Open
Abstract
Background Rocuronium-induced injection pain causes withdrawal movements. These movements may cause accidental disruption of indwelling needles. Generic rocuronium contains low-acid concentration buffer solution compared with original rocuronium. In animal experiments, it has been suggested that the difference of the buffer solution may alleviate injection pain. The purpose of this study was to identify the difference of injection pain between original and generic rocuronium in pediatric population. Material and Methods Patients ranging in age from 1 to 15 years, American Society of Anesthesiologists physical status I or II, undergoing elective surgeries were randomly allocated to two groups; generic rocuronium group (Group R) and original rocuronium (Eslax®) group (Group E). Following anesthetic induction with oxygen, nitrous oxide, and sevoflurane, original or generic rocuronium (1 mg/kg) was administered via intravenous catheter. The difference of vital signs and withdrawal movement associated with rocuronium injection were evaluated. Results A total of 64 patients were included in the study. Three patients were excluded. Twenty-nine patients were assigned to Group E and 32 patients to Group R. There was no significant difference in mean arterial pressure and heart rate. No withdrawal movements were observed in both groups. Conclusion There was no significant difference in injection pain between original and generic rocuronium under inhalational induction.
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Affiliation(s)
- Fumio Watanabe
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 426 Nana-Chome, Morioka-Cho, Obu-City, Aichi, Japan
| | - Hiromi Kako
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 426 Nana-Chome, Morioka-Cho, Obu-City, Aichi, Japan
| | - Mitsunori Miyazu
- Department of Anesthesiology, Aichi Children's Health and Medical Center, 426 Nana-Chome, Morioka-Cho, Obu-City, Aichi, Japan
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MacDougall T, Cunningham S, Whitney L, Sawhney M. Improving pediatric experience of pain during vaccinations: a quality improvement project. Int J Health Care Qual Assur 2020; 32:1034-1040. [PMID: 31282265 DOI: 10.1108/ijhcqa-07-2018-0185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). DESIGN/METHODOLOGY/APPROACH The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. FINDINGS Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. RESEARCH LIMITATIONS/IMPLICATIONS This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. PRACTICAL IMPLICATIONS Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. ORIGINALITY/VALUE This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
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Affiliation(s)
| | | | - Leeann Whitney
- North Bay Nurse Practitioner-Led Clinic, North Bay, Canada
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Nimmaanrat S, Jongjidpranitarn M, Prathep S, Oofuvong M. Premedication with oral paracetamol for reduction of propofol injection pain: a randomized placebo-controlled trial. BMC Anesthesiol 2019; 19:100. [PMID: 31185906 PMCID: PMC6560875 DOI: 10.1186/s12871-019-0758-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/14/2019] [Indexed: 11/20/2022] Open
Abstract
Background To compare the effect of premedication with 2 different doses of oral paracetamol to prevent pain at propofol intravenous injection. Methods We conducted a double-blind randomized controlled trial in which patients scheduled for induction of general anesthesia with intravenous propofol received either a placebo, 500 mg or 1000 mg of oral paracetamol (P500 and P1000, respectively) 1 h prior to induction. Two mg/kg of propofol was injected at a rate of 600 ml/hr. After 1/4 of the full dose had been injected, the syringe pump was paused, and patients were asked to rate pain at the injection site using a verbal numerical rating score (VNRS) from 0 to 10. Results Three hundred and twenty-four patients were included. Pain intensity was lower in both P500 and P1000 groups (median VNRS [interquartile range] = 2 [0–3] and 4 [2–5], respectively) than in the placebo group (8 [7–10]; P < 0.001)*. The rate of pain was lower in the P1000 group (70.4%) than in both the P500 and the placebo group (86.1 and 99.1%, respectively; P < 0.001)*. The respective rates of mild (VNRS 1–3), moderate (VNRS 4–6) and severe pain (VNRS 7–10) were 47.2, 23.2 and 0% in the P1000 group, 28.7, 50 and 7.4% in the P500 group, and 0, 22.2 and 76.9% in the placebo group (P < 0.001* for between group comparisons). Tolerance was similar in the 3 groups. Conclusions A premedication with oral paracetamol can dose-dependently reduce pain at propofol intravenous injection. To avoid this common uncomfortable concern for the patients, this well-tolerated, available and cheap treatment appears as an option to be implemented in the current practice. Trial registration TCTR20150224002. Prospectively registered on 24 February 2015.
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Affiliation(s)
- Sasikaan Nimmaanrat
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand.
| | - Manasanun Jongjidpranitarn
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand
| | - Sumidtra Prathep
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand
| | - Maliwan Oofuvong
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, 90110, Thailand
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Fowler S, Crowley C, Drum M, Reader A, Nusstein J, Beck M. Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study. Anesth Prog 2019; 65:231-236. [PMID: 30715932 DOI: 10.2344/anpr-65-03-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There is evidence that the Computer-Controlled Local Anesthetic Device (CCLAD) decreases the pain of oral injections. The purpose of this study was to evaluate injection pain of the inferior alveolar nerve block (IANB) using the CCLAD in an upright position versus a supine position. Additionally, we evaluated solution deposition pain with the CCLAD when compared to previous studies using a traditional syringe. One hundred ten asymptomatic subjects were randomly given IANBs using 2% lidocaine with 1:100,000 epinephrine while in an upright sitting position and supine position, at 2 different appointments, spaced at least 2 weeks apart. Each subject rated the pain for needle insertion, needle placement, and solution deposition on a Heft-Parker visual analogue scale. Pain ratings were compared between the upright and supine positions using a repeated-measures analysis of variance with post hoc testing using the Tukey-Kramer procedure. Moderate to severe pain was reported by 10% to 13% of the patients for needle insertion, 74% to 75% for full needle placement, and 8% to 10% for solution deposition. There was no significant difference between groups for phases of the injection. When comparing the injection phases within the groups, the needle placement phase of the injection was statistically more painful than both the needle insertion phase and solution deposition phase ( p = .0001). Using the CCLAD, IANB injection pain of the supine and upright positions was not statistically different. Needle placement was the most painful phase of the injection. Solution deposition pain was less with the CCLAD when compared to other studies of the IANB using a traditional syringe.
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Affiliation(s)
- Sara Fowler
- Assistant Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus
| | - Chase Crowley
- Former Graduate Student in Endodontics, The Ohio State University, Columbus
| | - Melissa Drum
- Associate Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus
| | - Al Reader
- Professor, Division of Endodontics, The Ohio State University, Columbus
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus
| | - Mike Beck
- Emeritus Associate Professor, Division of Biosciences, The Ohio State University, Columbus
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20
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Jacobse J, ten Voorde W, Rissmann R, Burggraaf J, ten Cate R, Schrier L. The effect of repeated methotrexate injections on the quality of life of children with rheumatic diseases. Eur J Pediatr 2019; 178:17-20. [PMID: 30448866 PMCID: PMC6311192 DOI: 10.1007/s00431-018-3286-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
In clinical practice, the burden of repeated injections in children with rheumatic disease receiving disease-modifying anti-rheumatic drugs is significant. To investigate the nature and extent of impact on the quality of life after repeated injections, we conducted a literature review. Two relevant papers were identified, both about children with juvenile idiopathic arthritis (JIA) being administered methotrexate. The results suggest that the combination of needle fear, impact of methotrexate treatment, and procedural consequences, e.g., blood sampling, all contribute to the distress and the loss of quality of life of children with JIA. Remarkably, no studies examining fear of injections or injection pain in children with rheumatic diseases receiving biologicals were identified.Conclusion: Strategies to optimize administration of disease modifying anti-rheumatic drugs should be systematically investigated. What is Known: • Repeated parenteral administration of drugs is burdensome for children with rheumatic diseases. What is New: • Needle fear should be investigated systematically to optimize administration of disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Justin Jacobse
- Department of Pediatric Rheumatology Willem-Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ,Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Wouter ten Voorde
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Robert Rissmann
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Jacobus Burggraaf
- Centre for Human Drug Research, Zernikedreef 8, 2333 CL Leiden, The Netherlands ,Leiden Academic Center for Drug Research, Einsteinweg 55, 2333 CC Leiden, The Netherlands
| | - Rebecca ten Cate
- Department of Pediatric Rheumatology Willem-Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Lenneke Schrier
- Department of Pediatric Rheumatology Willem-Alexander Children's Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Lee VY, Booy R, Skinner R, Edwards KM. The effect of exercise on vaccine-related pain, anxiety and fear during HPV vaccinations in adolescents. Vaccine 2018; 36:3254-3259. [PMID: 29709446 DOI: 10.1016/j.vaccine.2018.04.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION With increased school-based vaccinations for improved coverage rates and practicality, the World Health Organization (WHO) recently endorsed research to identify possible interventions to reduce vaccine-related pain in mass clinical and school-based settings. In particular, the lack of research in adolescents indicate a particular need in this population. Acute exercise has analgesic effects and has been used as a behavioural adjuvant to vaccination. Here, we examine the effect of exercise on vaccine-related pain, anxiety and fear in adolescents, during a school-based program for HPV vaccinations. METHODS 116 students (Female: 61, Male: 55) aged 11-13 years were randomly allocated to either an Exercise (n = 60) or Control (n = 56) group. All participants completed demographic and Trait-anxiety questionnaires prior to receiving the vaccine according to usual care. The Exercise group also performed upper body exercise for 15 min prior to receiving the vaccine. Immediately after the vaccine administration, all participants reported on pain, anxiety and fear at the time of receiving the vaccine. RESULTS Female adolescents in the Exercise group reported significantly less pain (3.64; 95% CI, 2.98-4.30) than Controls (4.58; 95% CI, 3.96-5.19; p = 0.04). Further, females reported greater pain and anxiety than males in the Control group but not the Exercise group. CONCLUSION This study supports the use of exercise prior to vaccine administration, especially in female adolescents who are particularly vulnerable to negative experiences during vaccination procedures. Furthermore, the ease of application, as well as the benefit of exercise, provides support for the use of simple exercise prior to vaccination in mass vaccination settings. Clinical trial registry: ANZCTR, ACTRN12614001185651.
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Affiliation(s)
- V Y Lee
- The University of Sydney, Faculty of Health Sciences & Charles Perkins Centre, Sydney, Australia.
| | - R Booy
- The University of Sydney, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
| | - R Skinner
- University of Sydney, Dept of Paediatrics & Adolescent Health, Children's Hospital at Westmead, Australia
| | - K M Edwards
- The University of Sydney, Faculty of Health Sciences & Charles Perkins Centre, Sydney, Australia
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Sargın M, Uluer MS, Aydoğan E. Hyoscine N-Butylbromide for Preventing Propofol Injection Pain: A Randomized, Placebo-Controlled and Double-Blind Study. Med Princ Pract 2018; 27:39-43. [PMID: 29402789 PMCID: PMC5968228 DOI: 10.1159/000486747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 01/07/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In this study, the aim was to investigate the effect of hyoscine N-butylbromide (HnBB) pretreatment on pain during propofol injection. SUBJECTS AND METHODS In this prospective, randomized, placebo-controlled and double-blind trial, 60 patients scheduled to undergo routine outpatient surgery under general anesthesia were randomly allocated to 2 groups, the HnBB (n = 30) and sodium chloride (n = 30) groups. Twenty seconds after the injection of 20 mg HnBB or 0.9 % sodium chloride, a 50-mg dose of propofol was injected in 2-3 s. Ten seconds later, the pain intensity was assessed using a 4-point scale: no pain (0), mild (1), moderate (2), and severe (3) pain. The Student t test was used for the analysis of parametric data and the Pearson χ2 test for categorical data. RESULTS The occurrence of pain in the HnBB group (43.3%) was significantly lower than the control group (73.3%) (p < 0.018). Of the 30 patients in each group, 10 in the control group and 3 in the HnBB group experienced severe pain (p = 0.001). CONCLUSIONS Pretreatment with 20 mg HnBB significantly reduced propofol injection pain compared to placebo.
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Affiliation(s)
- Mehmet Sargın
- *Mehmet Sargın, MD, Department of Anaesthesiology and Reanimation, Konya Training and Research Hospital, Yeni Meram, TR-42090 Konya (Turkey), E-Mail
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Bonar T, Nusstein J, Reader A, Drum M, Fowler S, Beck M. Anesthetic Efficacy of Articaine and Lidocaine in a Primary Intraseptal Injection: A Prospective, Randomized Double-Blind Study. Anesth Prog 2017; 64:203-211. [PMID: 29200372 DOI: 10.2344/anpr-64-04-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Additional studies are needed to evaluate intraseptal anesthesia in the mandibular first molar. The purpose of this study was to compare the anesthetic efficacy of a primary intraseptal injection of articaine and lidocaine, administered with a computer-controlled local anesthetic delivery (CCLAD) system, in asymptomatic mandibular first molars. Using a crossover design, 100 subjects randomly received intraseptal injections of 1.4 mL of 4% articaine and 2% lidocaine, both with 1:100,000 epinephrine, at 2 separate appointments. Injections were given in the interdental papillae, mesial (0.7 mL) and distal (0.7 mL) to the first molar. An electric pulp tester was used to test for pulpal anesthesia. Pain of injection, postoperative pain, and pulse rate were also evaluated. Data were statistically analyzed. Anesthetic success rate for the mandibular first molar was 32% for articaine and 30% for lidocaine, with no statistically significant difference (p = .8689) between the two. No significant differences were found between formulations for pain of injection. The intraseptal injection did not cause a clinically meaningful increase in pulse rate. Postoperative pain decreased each day with no significant differences between formulations. In conclusion, a primary intraseptal injection does not achieve a high success rate of pulpal anesthesia in the mandibular first molar.
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Affiliation(s)
- Tera Bonar
- Former Graduate Student in Endodontics (currently in practice limited to endodontics, Beachwood, Ohio), The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Associate Professor and Advanced Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Assistant Professor and Predoctoral Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Mike Beck
- Emeritus Associate Professor, Division of Oral Biology, The Ohio State University, Columbus, Ohio
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Abstract
Objective: Propofol is a new anesthetic agent in clinical practice, but randomized double-blinded prospective studies on its role in pediatric anesthesia remain limited. We aimed to compare the preventive effects of pre-injected lidocaine or ketamine and its pre-mixture on the anesthesia-induced injection pain of propofol using a randomized double-blinded prospective method, and to compare the outcomes with those of medium-/long-chain propofol (M/LCT). Methods: A total of 360 pediatric patients (aged 5-12 years old) who received elective surgery were randomly divided into six groups (n= 60) as follows. S group: control group; L group: lidocaine group; L + P group: lidocaine + propofol group; K group: ketamine group; K + P group: ketamine + propofol group; M group: M/LCT group. After the drug fluid completely entered the cubital vein, the venous access was closed. During propofol injection, the injection pain was scored using the VRS 4-point scale. Meanwhile, the heart rates before and during injection were recorded, the adverse reactions during and after injection were observed, and the incidence rate and degree of pain were evaluated. Results: The VRS 4-point scale showed that the incidence rates of injection pain of S group, L group, L + P group, K group, K + P group and M group were 78.3%, 66.67%, 51.66%, 43.33%, 48.33% and 45% respectively. The incidence rates of injection pain of all experimental groups were significantly lower than that of S group (P<0.01). The incidence rates of injection pain of L + P group, K group, K + P group and M group were significantly lower than that of L group (P<0.05). The differences among the other groups were not statistically significant. Conclusions: Intravenous pre-injection of lidocaine, ketamine or those mixed with propofol can all significantly reduce the incidence rate of injection pain of propofol.
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Affiliation(s)
- Dabin Cheng
- Dabin Cheng, Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China
| | - Lu Liu
- Lu Liu, Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China
| | - Zheng Hu
- Zheng Hu, Department of Anesthesiology, Children's Hospital of Nanjing Medical University, No. 72 Guangzhou Road, Nanjing 210008, Jiangsu Province, China
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Lee JH, Kim SH, Park ES. The Efficacy and Safety of HA IDF Plus (with Lidocaine) Versus HA IDF (Without Lidocaine) in Nasolabial Folds Injection: A Randomized, Multicenter, Double-Blind, Split-Face Study. Aesthetic Plast Surg 2017; 41:422-8. [PMID: 28032168 DOI: 10.1007/s00266-016-0769-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/09/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Injection-related pain of dermal fillers is a consistent and bothersome problem for patients undergoing soft tissue augmentation. Reducing the pain could improve overall patient satisfaction. OBJECTIVE The purpose of this study was to compare the pain relief, efficacy, and safety of HA IDF plus containing lidocaine with HA IDF without lidocaine during correction of nasolabial folds (NLFs). METHODS Sixty-two subjects were enrolled in a randomized, multicenter, double-blind, split-face study of HA IDF plus and HA IDF for NLF correction. For split-face study, HA IDF plus was injected to one side of NLF, and HA IDF was injected to the other side. The first evaluation variable was the injection site pain measured using a 100-mm visual analogue scale (VAS). The second evaluation variables included the global aesthetic improvement scale, wrinkle severity rating scale, and adverse events. RESULTS Immediately after injection, 91.94% of subjects experienced at least 10 mm decrease in VAS scores at the side injected with HA IDF plus compared with HA IDF, and the rate of subjects is statistically significant. The two fillers were not significantly different in safety profile or wrinkle correction during the follow-up visit. CONCLUSIONS HA IDF plus significantly reduced the injection-related pain during NLFs correction compared with HA IDF without altering clinical outcomes or safety. Both HA IDF plus and HA IDF were considerably tolerated and most adverse reactions were mild and transient. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Abstract
Background Propofol injection pain (PIP) has been adequately studied during the past decades. However, patients’ opinion on this problem and the incidence of patients’ recall of this brief discomfort are still unknown. Thus, we conducted this study to know the patients’ perspectives on PIP and provide useful information about the incidence of recall of PIP under our routine general anesthesia. Methods Five hundred preoperative questionnaires were distributed to patients who were scheduled for elective open thyroidectomy under general anesthesia from May 2016 to July 2016. They were asked to rank ten possible adverse effects associated with general anesthesia from their most undesirable to their least undesirable effect. Patients who completed the preoperative questionnaires were asked whether they could recall PIP and to grade the severity of PIP on the first postoperative day. Results A total of 448 preoperative questionnaires were returned and analyzed with an efficient rate of 89.6%. Incisional pain was ranked as most undesirable, followed (in order) by vomiting, gagging on the tracheal tube, nausea, sore throat, propofol injection pain, shivering, intravenous puncture pain, and anxiety. The majority (91.5%) of surveyed patients could not recall any discomfort or pain during anesthetics injection. Of those who could recall PIP, 89.5% grade it as mild pain, 7.9% moderate pain, and 2.6% severe pain. Conclusions Most of patients undergoing elective open thyroidectomy in our hospital viewed PIP as a relatively minor problem. The incidence of recall of PIP was low and the majority of those who recalled regarded it as mild, temporary and acceptable pain. However, further investigations into propofol injection pain may be warranted as patients’ perspectives on propofol injection pain and its severity may differ between patient populations.
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Affiliation(s)
- Wen Wang
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Linxin Wu
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Chaobin Zhang
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Li Sun
- Department of Anesthesiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
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Madan HK, Singh R, Sodhi GS. Comparsion of Intravenous Lignocaine, Tramadol and Keterolac for Attenuation of Propofol Injection Pain. J Clin Diagn Res 2016; 10:UC05-8. [PMID: 27630928 DOI: 10.7860/jcdr/2016/20444.8118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/19/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Propofol possesses many characteristics of an ideal intravenous anaesthetic agent, providing a smooth induction and a rapid recovery. However, it has been reported to evoke considerable pain on injection in 10-100% of patients. The cause of pain upon intravenous injection of propofol remains a mystery. AIM To study and compare the efficacy of Lignocaine, Tramadol and Ketorolac in minimizing the propofol injection pain. MATERIALS AND METHODS Hundred adult patients (ASA grade I and grade II) scheduled for elective surgery under general anaesthesia with propofol as an inducing agent were considered for the study. Patients were randomly divided into 4 groups of 25 patients each Group L (lignocaine) Group T (tramadol) Group K (ketorolac) and Group N (normal saline). Pain scores were measured by the investigator immediately following injection of propofol. All patients' responses were graded by a verbal pain score. RESULTS All the results were tabulated and analysed using the one-way ANOVA and z-test. There was no statistically significant difference among group L (24%), T (28%) and K (28%) for pain on injection, but significant difference of all 3 groups was there when compared with group N. CONCLUSION Intravenous lignocaine, tramadol and ketorolac all 3 drugs significantly reduce propofol injection pain. However, lignocaine appears to be more acceptable cause of less pain and fewer side effects as compared to tramadol and ketorolac.
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Affiliation(s)
- Harprit Kaur Madan
- Assistant Professor, Department of Anesthesiology and Critical Care, HBT Medical College and Dr. R.N. Cooper Municipal Gen. Hospital , Mumbai, Maharashtra, India
| | - Rajinder Singh
- Assistant Professor, Department of General Surgery, TN Medical College and BYL Nair Ch. Hospital , Mumbai, Maharashtra, India
| | - Gurdip Singh Sodhi
- Senior Consultant, Department of Anesthesia and Critical Care, MD Oswal Cancer Charitable Hospital and Research Centre , Ludhiana, Punjab, India
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Abstract
Effective pain control during local anesthetic injection is the cornerstone of behavior guidance in pediatric dentistry. The aim of this study was to evaluate the practical efficacy of a 2-stage injection technique in reducing injection pain in children. This was a split-mouth, randomized controlled crossover trial. One hundred cooperative children aged 7 to 13 years in need of bilateral local anesthetic injections (inferior alveolar nerve block, posterior superior alveolar nerve block, or maxillary and mandibular buccal infiltrations) for restorative, endodontic, and extraction treatments were recruited for the study. Children were randomly allocated to receive either the 2-stage injection technique or conventional technique at the first appointment. The other technique was used at the successive visit after 1 week. Subjective and objective evaluation of pain was done using the Wong-Baker FACES Pain Rating Scale (FPS) and Sound Eye Motor (SEM) scale, respectively. The comparison of pain scores was done by Wilcoxon sign-rank test. Both FPS and SEM scores were significantly lower when the 2-stage injection technique of local anesthetic nerve block/infiltration was used compared with the conventional technique. The 2-stage injection technique is a simple and effective means of reducing injection pain in children.
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Affiliation(s)
- Valasingam Sandeep
- Department of Pediatric Dentistry, GPR Dental College and Hospital, Kurnool, Andhra Pradesh, India
| | - Manikya Kumar
- Department of Pediatric Dentistry, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India, and
| | - P Jyostna
- Private Practice, Care and Cure Dental Specialties, Kurnool, Andhra Pradesh, India
| | - Vijay Duggi
- Department of Pediatric Dentistry, GPR Dental College and Hospital, Kurnool, Andhra Pradesh, India
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Kizilcik N, Menda F, Bilgen S, Keskin O, Koner O. Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial. Korean J Anesthesiol 2015; 68:556-60. [PMID: 26634078 PMCID: PMC4667140 DOI: 10.4097/kjae.2015.68.6.556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/16/2015] [Accepted: 04/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Propofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain. METHODS The patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 µg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Student's t-tests and Fisher's exact tests; P < 0.05 was considered to indicate statistical significance. RESULTS The demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001). CONCLUSIONS This study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain.
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Affiliation(s)
- Nurcan Kizilcik
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ferdi Menda
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Sevgi Bilgen
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ozgül Keskin
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ozge Koner
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
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Yılmaz Çakirgöz M, Demirel İ, Duran E, Özer AB, Hancı V, Türkmen ÜA, Aydın A, Ersoy A, Büyükyıldırım A. Effect of gabapentin pretreatment on myoclonus after etomidate: a randomized, double-blind, placebo-controlled study. Braz J Anesthesiol 2015; 66:356-62. [PMID: 27343784 DOI: 10.1016/j.bjane.2014.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 11/11/2014] [Indexed: 12/20/2022] Open
Abstract
AIM To evaluate the effects of three different doses of gabapentin pretreatment on the incidence and severity of myoclonic movements linked to etomidate injection. METHOD One hundered patients, between 18 and 60 years of age and risk category American Society of Anesthesiologists I-II, with planned elective surgery under general anesthetic were included in the study. The patients were randomly divided into four groups and 2h before the operation were given oral capsules of placebo (Group P, n=25), 400mg gabapentin (Group G400, n=25), 800mg gabapentin (Group G800, n=25) or 1200mg gabapentin (Group G1200, n=25). Side effects before the operation were recorded. After preoxygenation for anesthesia induction 0.3mgkg(-1) etomidate was administered for 10s. A single anesthetist with no knowledge of the study medication evaluated sedation and myoclonic movements on a scale between 0 and 3. Two minutes after induction, 2μgkg(-1) fentanyl and 0.8mgkg(-1) rocuronium were administered for tracheal intubation. RESULTS Demographic data were similar. Incidence and severity of myoclonus in Group G1200 and Group G800 were significantly lower than in Group P; sedation incidence and level were appreciably higher compared to Group P and Group G400. While there was no difference in the incidence of myoclonus between Group P and Group G400, the severity of myoclonus in Group G400 was lower than in the placebo group. In the two-hour period before induction other than sedation none of the side effects related to gabapentin were observed in any patient. CONCLUSION Pretreatment with 800mg and 1200mg gabapentin 2h before the operation increased the level of sedation and reduced the incidence and severity of myoclonic movements due to etomidate.
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Affiliation(s)
- Mensure Yılmaz Çakirgöz
- Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Şişli, İstanbul, Turkey.
| | - İsmail Demirel
- Fırat University, School of Medicine, Department of Anesthesiology and Reanimation, Elazığ, Turkey
| | - Esra Duran
- Şehit Kamil State Hospital, Gaziantep, Turkey
| | - Ayşe Belin Özer
- Fırat University, School of Medicine, Department of Anesthesiology and Reanimation, Elazığ, Turkey
| | - Volkan Hancı
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İzmir, Turkey
| | - Ülkü Aygen Türkmen
- Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Şişli, İstanbul, Turkey
| | - Ahmet Aydın
- Fırat University, School of Medicine, Department of Anesthesiology and Reanimation, Elazığ, Turkey
| | - Ayşın Ersoy
- Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Şişli, İstanbul, Turkey
| | - Aslıhan Büyükyıldırım
- Okmeydanı Training and Research Hospital, Department of Anesthesiology and Reanimation, Şişli, İstanbul, Turkey
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Makade CS, Shenoi PR, Gunwal MK. Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients. J Conserv Dent 2014; 17:169-74. [PMID: 24778516 PMCID: PMC4001276 DOI: 10.4103/0972-0707.128063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 12/03/2013] [Accepted: 01/06/2014] [Indexed: 11/08/2022] Open
Abstract
Introduction: Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Materials and Methods: Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student's t-test. Results: Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%). Both needle and pressure anesthesia was equally effective for carrying out the dental procedures. Conclusion: Patients experienced significantly less pain and fear (p<0.01) during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective.
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Affiliation(s)
- Chetana Sachin Makade
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College & Research Centre, Nagpur, Maharashtra, India
| | - Pratima R Shenoi
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College & Research Centre, Nagpur, Maharashtra, India
| | - Mohit K Gunwal
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College & Research Centre, Nagpur, Maharashtra, India
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Honca M, Purtuloglu T, Honca T, Sizlan A, Deniz S, Kose A, Ogur R, Horasanlı E. Effects of the menstrual cycle on injection pain due to rocuronium. J Clin Anesth 2013; 25:399-402. [PMID: 23965205 DOI: 10.1016/j.jclinane.2013.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To investigate the effect of the menstrual cycle on rocuronium injection pain. DESIGN Prospective, randomized, double-blinded study. SETTING Academic medical center. PATIENTS 80 ASA physical status 1 and 2 women scheduled for elective surgery with general anesthesia. MEASUREMENTS Patients were divided into two groups according to their time in the menstrual cycle. Forty patients at days 8 to 12 of the menstrual cycle were considered to be at the follicular phase (Group F), and 40 patients at days 20 to 24 of the menstrual cycle were considered to be at the luteal phase (Group L).Withdrawal movements were recorded. MAIN RESULTS Overall frequency of withdrawal movements was significantly higher in Group L than Group F (P < 0.001). The mean withdrawal movement score was 1.77 ± 0.76 in Group L and 0.52 ± 0.67 in Group F. CONCLUSION Menstrual cycle phases affect the severity of rocuronium injection pain. Women exhibit greater pain sensitivity from rocuronium injection in the luteal phase than the follicular phase.
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Affiliation(s)
- Mehtap Honca
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Tarık Purtuloglu
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Tevfik Honca
- Department of Medical Biochemistry, Gulhane Medical Faculty, Ankara, Turkey
| | - Ali Sizlan
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Suleyman Deniz
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
| | - Arzu Kose
- Department of Anesthesiology and Reanimation, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Recai Ogur
- Department of Environmental Health, Gulhane Medical Faculty, Ankara, Turkey
| | - Eyup Horasanlı
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
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Abstract
Background We designed this double-blind, placebo-controlled study to compare the efficacy of remifentanil in reducing the pain of both propofol and rocuronium injection during rapid-sequence induction. Methods Ninety-five patients, scheduled for elective surgery under general anesthesia, were divided into 3 groups: saline (Group S, n = 31), remifentanil 1 µg/kg (Group R, n = 32), and lidocaine 1.5 mg/kg (Group L, n = 32) were administered after tourniquet application. The occlusion was released after 1 min and 5 ml of 1% propofol was injected over 10 s. Pain on propofol injection was evaluated by a 10-point verbal numeric rating scale (VNRS). The rest of the induction dose of propofol and 1 mg/kg of rocuronium, were injected. Pain on rocuronium injection was evaluated by a four-point score (FPS). Results The VNRS of propofol injection was as follows: R (0.78) = L (1.34) < S (4.26). The incidence of withdrawal response due to rocuronium was as follows: R (6.3%) < L (53.1%) < S (83.9%). The FPS of rocuronium injection was as follows: R (0.81) < L (1.78) < S (2.93). Conclusions Pretreatment with a bolus of remifentanil was effective in simultaneously reducing injection pain of propofol and rocuronium. In addition, remifentanil pretreatment was more effective in suppression of withdrawal response by rocuronium than lidocaine.
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Affiliation(s)
- Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, Seoul, Korea
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Chung DH, Kim NS, Lee MK, Jo HK. The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol. Korean J Anesthesiol 2011; 60:83-9. [PMID: 21390162 PMCID: PMC3049887 DOI: 10.4097/kjae.2011.60.2.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/01/2010] [Accepted: 09/07/2010] [Indexed: 11/10/2022] Open
Abstract
Background Propofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol. Methods The candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 µg/kg, 0.2 µg/kg or 0.3 µg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded. Results There were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 µg/kg group than normal saline and sufentanil 0.1 µg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 µg/kg and 0.3 µg/kg group experienced mild cough, one from sufentanil 0.3 µg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 µg/kg group showed clinical symptoms of phlebitis in the injection area. Conclusions Pretreatment with sufentanil 0.3 µg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.
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Affiliation(s)
- Dong Hun Chung
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
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35
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Kim HS, Cho KR, Lee JH, Kim YH, Lim SH, Lee KM, Cheong SH, Kim YJ, Shin CM, Lee JY. Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine. Korean J Anesthesiol 2010; 59:310-3. [PMID: 21179291 PMCID: PMC2998649 DOI: 10.4097/kjae.2010.59.5.310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/17/2010] [Accepted: 07/09/2010] [Indexed: 11/25/2022] Open
Abstract
Background Similar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture. Methods One hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe. Results The incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05). Conclusions The lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.
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Affiliation(s)
- Hyun-Sik Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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