利多卡因預防丙泊酚注射痛效果的Meta分析_《中國循證醫學雜志》

作者：

牛麗 , 宣燕 ,  王江

新疆醫科大學第一附屬醫院（烏魯木齊 830054）;

關鍵詞：

利多卡因丙泊酚注射痛系統評價 Meta分析隨機對照試驗

DOI：

10.7507/1672-2531.20130193

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目的　系統評價利多卡因預防丙泊酚注射痛的效果。
方法　計算機檢索The Cochrane Library（2012年第4期），PubMed、MEDLINE、Ovid、HighWire、EMbase、CBM和CNKI等數據庫，收集采用利多卡因預防丙泊酚注射痛的隨機對照試驗（RCT），檢索時限均為1985年1月～2012年12月，并追溯納入研究的參考文獻。由2位評價者按照納入與排除標準獨立篩選文獻、提取資料和評價質量后，采用RevMan 5.1軟件進行Meta分析。
結果　最終納入15篇文獻，共1 332個患者。Meta分析結果顯示：丙泊酚內混入不同劑量利多卡因，患者注射痛的發生率明顯低于空白對照組，兩組差異有統計學意義［RR=0.36，95%CI（0.30，0.44），P lt;0.000 01］；預先給予不同劑量利多卡因，患者注射痛發生率明顯低于空白對照組，兩組差異有統計學意義［RR=0.59，95%CI（0.47，0.75），P lt;0.000 1］；扎止血帶后給予不同劑量利多卡因，患者注射痛的發生率明顯低于空白對照組，兩組差異有統計學意義［RR=0.44，95%CI（0.37，0.52），P lt;0.000 01］。
結論　利多卡因能減少丙泊酚注射痛。扎止血帶后給予40 mg利多卡因是相對有效減少丙泊酚注射痛的方法，且其更適合無術前用藥的門診靜脈全麻患者。

引用本文： 牛麗,宣燕,王江. 利多卡因預防丙泊酚注射痛效果的Meta分析. 中國循證醫學雜志, 2013, 13(9): 1129-1136. doi: 10.7507/1672-2531.20130193 復制

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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利多卡因預防丙泊酚注射痛效果的Meta分析

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《中國循證醫學雜志》

利多卡因預防丙泊酚注射痛效果的Meta分析

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