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PREVENTION OF PAIN ON PROPOFOL INJECTION: A COMPARISON OF LIGNOCAINE WITH A COMBINATION OF METOCLOPRAMIDE / LIGNOCAINE.
ABSTRACT
Injection pain which distresses patients is a major disadvantage of the induction agent, propofol and has been reported in 28-90% of patients. Lignocaine pretreatment is arguably the most popular method for reducing this pain but this drug cannot entirely eliminate the problem. The aim of this study was to examine the analgesic effect of lignocaine / metoclopramide combination, compared with lignocaine alone, during propofol injection in an adult Nigerian population at the Lagos University Teaching Hospital (LUTH).
Seventy (70) American Society of Anesthesiologists (ASA) physical status class I and II adult patients: Forty-three (43) Females and twenty-seven males (27) undergoing various elective surgical procedures under intravenous general anaesthesia were included in this randomized, double-blind, interventional study. The effectiveness of a combination of i.v lignocaine 20mg/ i.v metoclopramide 10mg ( group A, n=35) when mixed with i.v propofol 2.0mg-kg in reducing pain on injection at induction of anaesthesia was compared with using i.v lignocaine 20mg alone mixed with i.v propofol 2.0mg-kg into a dorsal hand vein ( group B, n=35). During a ten-second pause after the first 25% of the calculated propofol dose (mixed with study drugs) was given, the patients were asked standard questions regarding pain on injection before induction of anaesthesia. The incidence and intensity of pain were assessed using a four point Verbal Rating
Scale 0 to 3 (0=no pain on prompting, 1=Mild pain, 2=Moderate pain, 3=Severe pain ) during propofol injection.
Thereafter, the induction of anaesthesia was continued and completed with the remainder of the calculated propofol dose and endotracheal intubation facilitated with 0.1mg/kg pancuronium in the two groups. Heart rate (HR), Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial blood pressure (MAP) were recorded 5 minutes pre-induction (which was taken as baseline) and every 2.5 minutes after induction using multiparameter monitor (Cardiocarp/5). Values of HR, SBP, DBP and MAP were compared with baseline values in each group.
A total of seventy patients were studied, comprising twenty-seven men (38.57%) and forty-three women (61.43%), with 35 patients in each group. Group A had thirteen males (37.14%) and twenty-two females (62.86%), Group B had fourteen males (40.0%) and twenty-one females (60.0%), one patient was dropped from the study in each group due to painful cannulation, remaining 34 patients in each group. Eleven (11) patients (32.35%) complained of pain in the lignocaine group (control intervention), compared with four patients (11.77%) in the combination group (experimental intervention).
With regard to (occurrence) incidence of pain on injection, the difference between the two groups was statistically significant P=0.041, (P<0.05) using the Chi-square test. There was no statistical difference in Verbal Pain Response (intensity) Scores P= 0.118, (P > 0.05) and recall of pain P= 0.077, (P > 0.05) using the Chi-square test, between the groups. There was no statistically significant difference between the two groups with regard to variations in haemodynamic parameters compared with baseline values before and after administration of study drugs.
After completion of the study, side effects (arrhythmias, injection site reactions, extra pyramidal reactions) and complications were not observed following the use of the study drugs.
A lignocaine / metoclopramide combination is more effective than lignocaine alone for reducing pain on injection of propofol in a dorsal hand vein.
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