Efeitos do tratamento prévio com lidocaína, paracetamol e lidocaína-fentanil por via venosa na dor causada pela injeção de propofol. Estudo comparativo

Abstract

BACKGROUND AND OBJECTIVES: Performed a randomized, double blind study to assess the efficacy of intravenous (IV) pretreatment with lidocaine, IV paracetamol (Perfalgan®) or lidocaine mixed with fentanyl in reducing propofol injection pain. METHODS: Immediately after venous occlusion with a rubber tourniquet on the patient's arm IV lidocaine 1% 4 mL (Group L, n = 50), IV paracetamol (Perfalgan®) 4 mL (40 mg) (Group R, n = 50), lidocaine 2% mixed with 100 μg fentanyl (Group LF, n = 50) or normal saline 4 mL (Group P, n = 50; as placebo control) was given to 200 adult patients. The release of the venous occlusion was done after 60s and followed by intravenous administration of propofol 2.5 mg.kg-1 at rate of 0.5 mg.s-1 through a 20G catheter inserted in hand dorsum vein. Pain assessment was made during the propofol injection. This included movement of hand, spontaneous verbal expressions of pain, frowning, and moaning during the injection of propofol. RESULTS: Lidocaine-fentanyl (70% pain free), and lidocaine (68% pain free) significantly reduced propofol injection pain more than paracetamol (54% pain free) and more than placebo (36% pain free) (p < 0.05). The difference in reducing the incidence of propofol injection pain between lidocaine and lidocaine-fentanyl did not reach statistical significance. There was a significant superiority of paracetamol compared to placebo (p < 0.05). CONCLUSIONS: Propofol, a commonly used anesthetic. Given as a venous retention pretreatment 60 seconds before propofol, lidocaine and lidocaine-fentanyl were found to significantly reduce the propofol injection pain, whereas IV paracetamol (Perfalgan®) slightly reduced the propofol injection pain. © Sociedade de Anestesiologia, 2007.