Effects of Lidocaine on Preventing Pain on Injection of Propofol: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

NIU Li , XUAN Yan ,  WANG Jiang

Department of Anesthesiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding?author：

WANG Jiang, Email: 710985359@qq.com

Keywords：

Lidocaine; Propofol; Pain on injection; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130193

Video：

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Objective 　To systematically review the effects of lidocaine for preventing pain on injection of propofol.
Methods 　Databases including The Cochrane Library (Issue 4, 2012), PubMed, MEDLINE, Ovid, HighWire, EMbase, CBM and CNKI were searched electronically to collect literature published from January, 1985 to December, 2012. Randomized controlled trials (RCTs) were indentified about lidocaine for preventing injection pain of propofol. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software.
Results 　Fifteen trials involved 1 332 patients were included. The results of meta-analysis indicated that, adding lidocaine into propofol lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.36, 95%CI 0.30 to 0.44, P lt;0.000 01); using different doses of lidocaine before injection lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.59, 95%CI 0.47 to 0.75, P lt;0.000 1); using different doses of lidocaine after venous occlusion lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.44, 95%CI 0.37 to 0.52, P lt;0.000 01).
Conclusion 　Lidocaine could reduce the pain on injection of propofol. Using lidocaine 40 mg after venous occlusion is a relatively effective method to lower the incidence of pain on injection which is more suitable for outpatient who receive intravenous anesthesia without preoperation medication.

Citation： NIU Li,XUAN Yan,WANG Jiang. Effects of Lidocaine on Preventing Pain on Injection of Propofol: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(9): 1129-1136. doi: 10.7507/1672-2531.20130193 Copy

1.	付艷芳, 段宏軍, 賈瑞芳. 利多卡因和輸液部位對丙泊酚注射痛的影響. 中國醫刊, 2010, 45(9): 41-42.
2.	王寧華. 疼痛定量評定的進展. 中國臨床康復, 2009, 6(18): 2738-2739.
3.	Hinggins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studys. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (Updated March 2011). The Cochrane Collaboration, 2011. Available from:www.cochrane-handbook.org.
4.	Gajraj NM, Nathanson MH. Preventing pain during injection of propofol: the optimal dose of lidocaine. J Clin Anesth, 1996, 8(7): 575-577.
5.	King SY, Davis FM, Wells JE, et al. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg, 1992, 74(2): 246-249.
6.	Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia, 1988, 43(6): 492-494.
7.	McDonald DS, Jameson P. Injection pain with propofol. Reduction with aspiration of blood. Anaesthesia, 1996, 51(9): 878-880.
8.	Kwon JS, Kim ES, Cho KB, et al. Incidence of propofol injection pain and effect of lidocaine pretreatment during upper gastrointestinal endoscopy. Dig Dis Sci, 2012, 57(5): 1291-1297.
9.	Lee TW, Loewenthal AE, Strachan JA, et al. Pain during injection of propofol. The effect of prior administration of thiopentone. Anaesthesia, 1994, 49(9): 817-818.
10.	曾瑞峰, 唐巖峰, 何偉, 等. 利多卡因、芬太尼和布托啡諾分別用于預防丙泊酚注射痛的療效觀察. 海峽藥學, 2009, 43(10): 103-106.
11.	Kwak KH, Ha J, Kim Y. Efficacy of combination intravenous lidocaine and dexamethasone on propofol injection pain: a randomized, double-blind, prospective study in adult Korean surgical patients. Clin Ther, 2008, 30(6): 1113-1119.
12.	Jeon YH. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine. J Anesth, 2012, 26(5): 728-731.
13.	馬玉姍, 林雪梅, 周俊. 格拉司瓊復合利多卡因減輕異丙酚注射痛的隨機雙盲對照研究. 四川大學學報(醫學版), 2009, 40(3): 536-538.
14.	Salman AE, Salman MA, Saricaoglu F, et al. Pain on injection of propofol: a comparison of methylene blue and lidocaine. J Clin Anesth, 2011, 23(4): 270-274.
15.	Khaled M, El-Radaideh. Effect of pretreatment with lidocaine, intravenous paracetamol and lidocaine-fentanyl on propofol injection pain: a comparative study. Rev Bras Anestesiol, 2007, 57(1): 32-38.
16.	FuJii Y, Itakura M. Efficafy of the lidocaine/flurbiprofen axetil combination for reducing pain during the injection of propofol. Minerva Anestesiol, 2011, 77(7): 693-697.
17.	FuJii Y, Itakura M. A comparison of pretreatment with fentanyl and lidocaine preceded by venous occlusion for reducing pain on injection of propofol: a prospective, randomized, double-blind, placebo-controlled study in adult japanese surgical patients. Clin Ther, 2009, 31(10): 2107-2112.
18.	FuJii Y, Itakura M. Comparison of lidocaine, metoclopramide, and flurbiprofen axetil for reducing pain on injection of propofol in japanese adult surgical patients: a prospective, randomized, double-blind, parallel-goup, placebo-controlled study. Clin Ther, 2008, 30(2): 280-286.
19.	Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes: are both common and important to avoid? the perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
20.	Majedi H, Rabiee M, Khan ZH, et al. A comparison of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
21.	Niazi A, Galvin E, Elsaigh I, et al. A combination of lidocaine and nitrous oxide in oxide in oxygen is more effective in preventing pain on propofol injection than either treatment alone. Eur J Anaesthesiol, 2005, 22(4): 299-302.
22.	楊付明, 李剛, 馬曉瑜. 烏拉地爾、利多卡因預防氣管插管時心血管反應的臨床觀察. 寧夏醫學院學報, 2007, 29(3): 290-291.
23.	黃偉. 復合利多卡因全身靜脈麻醉對丙泊酚、瑞芬太尼用量的影響. 右江民族醫學院學報, 2006, 28(5): 802- 803.
24.	李后香. 全麻誘導中利多卡因預防芬太尼嗆咳反應的臨床觀察. 臨床軍醫雜志, 2012, 40(1): 86-87.
25.	Picard P, Tramer MR. Prevention of Pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
26.	王維秦, 吳新民. 利多卡因對大鼠海馬椎體神經元電壓依賴性鈉通道的作用. 中華麻醉學雜志, 2000, 20(10): 609-611.
27.	王琛, 王國林. 丙泊酚注射痛的機制及預防. 醫學綜述, 2006, 12(2): 106-108.
28.	Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011, 342(4): 1-18.
29.	Dedic A, Adam S, Gommers D, et al. Propofol injection pain: is it still an issue? The effect of premedication. Minerva Anestesiol, 2010, 76(9): 720-724.
30.	Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg, 1996, 82(3): 469-471.

1. 付艷芳, 段宏軍, 賈瑞芳. 利多卡因和輸液部位對丙泊酚注射痛的影響. 中國醫刊, 2010, 45(9): 41-42.
2. 王寧華. 疼痛定量評定的進展. 中國臨床康復, 2009, 6(18): 2738-2739.
3. Hinggins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studys. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (Updated March 2011). The Cochrane Collaboration, 2011. Available from:www.cochrane-handbook.org.
4. Gajraj NM, Nathanson MH. Preventing pain during injection of propofol: the optimal dose of lidocaine. J Clin Anesth, 1996, 8(7): 575-577.
5. King SY, Davis FM, Wells JE, et al. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg, 1992, 74(2): 246-249.
6. Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia, 1988, 43(6): 492-494.
7. McDonald DS, Jameson P. Injection pain with propofol. Reduction with aspiration of blood. Anaesthesia, 1996, 51(9): 878-880.
8. Kwon JS, Kim ES, Cho KB, et al. Incidence of propofol injection pain and effect of lidocaine pretreatment during upper gastrointestinal endoscopy. Dig Dis Sci, 2012, 57(5): 1291-1297.
9. Lee TW, Loewenthal AE, Strachan JA, et al. Pain during injection of propofol. The effect of prior administration of thiopentone. Anaesthesia, 1994, 49(9): 817-818.
10. 曾瑞峰, 唐巖峰, 何偉, 等. 利多卡因、芬太尼和布托啡諾分別用于預防丙泊酚注射痛的療效觀察. 海峽藥學, 2009, 43(10): 103-106.
11. Kwak KH, Ha J, Kim Y. Efficacy of combination intravenous lidocaine and dexamethasone on propofol injection pain: a randomized, double-blind, prospective study in adult Korean surgical patients. Clin Ther, 2008, 30(6): 1113-1119.
12. Jeon YH. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine. J Anesth, 2012, 26(5): 728-731.
13. 馬玉姍, 林雪梅, 周俊. 格拉司瓊復合利多卡因減輕異丙酚注射痛的隨機雙盲對照研究. 四川大學學報(醫學版), 2009, 40(3): 536-538.
14. Salman AE, Salman MA, Saricaoglu F, et al. Pain on injection of propofol: a comparison of methylene blue and lidocaine. J Clin Anesth, 2011, 23(4): 270-274.
15. Khaled M, El-Radaideh. Effect of pretreatment with lidocaine, intravenous paracetamol and lidocaine-fentanyl on propofol injection pain: a comparative study. Rev Bras Anestesiol, 2007, 57(1): 32-38.
16. FuJii Y, Itakura M. Efficafy of the lidocaine/flurbiprofen axetil combination for reducing pain during the injection of propofol. Minerva Anestesiol, 2011, 77(7): 693-697.
17. FuJii Y, Itakura M. A comparison of pretreatment with fentanyl and lidocaine preceded by venous occlusion for reducing pain on injection of propofol: a prospective, randomized, double-blind, placebo-controlled study in adult japanese surgical patients. Clin Ther, 2009, 31(10): 2107-2112.
18. FuJii Y, Itakura M. Comparison of lidocaine, metoclopramide, and flurbiprofen axetil for reducing pain on injection of propofol in japanese adult surgical patients: a prospective, randomized, double-blind, parallel-goup, placebo-controlled study. Clin Ther, 2008, 30(2): 280-286.
19. Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes: are both common and important to avoid? the perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
20. Majedi H, Rabiee M, Khan ZH, et al. A comparison of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
21. Niazi A, Galvin E, Elsaigh I, et al. A combination of lidocaine and nitrous oxide in oxide in oxygen is more effective in preventing pain on propofol injection than either treatment alone. Eur J Anaesthesiol, 2005, 22(4): 299-302.
22. 楊付明, 李剛, 馬曉瑜. 烏拉地爾、利多卡因預防氣管插管時心血管反應的臨床觀察. 寧夏醫學院學報, 2007, 29(3): 290-291.
23. 黃偉. 復合利多卡因全身靜脈麻醉對丙泊酚、瑞芬太尼用量的影響. 右江民族醫學院學報, 2006, 28(5): 802- 803.
24. 李后香. 全麻誘導中利多卡因預防芬太尼嗆咳反應的臨床觀察. 臨床軍醫雜志, 2012, 40(1): 86-87.
25. Picard P, Tramer MR. Prevention of Pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
26. 王維秦, 吳新民. 利多卡因對大鼠海馬椎體神經元電壓依賴性鈉通道的作用. 中華麻醉學雜志, 2000, 20(10): 609-611.
27. 王琛, 王國林. 丙泊酚注射痛的機制及預防. 醫學綜述, 2006, 12(2): 106-108.
28. Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011, 342(4): 1-18.
29. Dedic A, Adam S, Gommers D, et al. Propofol injection pain: is it still an issue? The effect of premedication. Minerva Anestesiol, 2010, 76(9): 720-724.
30. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg, 1996, 82(3): 469-471.

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