Pain on injection of methohexitone The use of lignocaine to modify pain on injection of methohexitone during anaesthesia for electroconvulsive therapy

Abstract

SummaryThe present study was designed to assess the incidence of pain when methohexitone was administered to 35 depressedpatients who had electroconvulsive therapy, and to determine whether the use of lignocaine could modijy this, without affecting seizure duration. The same patients were studied during three separate treatment sessions; they received either methohexitone alone or mixed with, or preceded by, lignocaine 10 mg. Six (17%) patients spontaneously complained of pain during injection of methohexitone alone: the use of lignocaine prior to methohexitone reduced this to zero ( p < 0.05). A total of 49% patients reported pain during injection of methohexitone; the use of lignocaine either mixed with, or given prior to, methohexitone significantly reduced this to 23% and 20% respectively ( p < 0.05). Seizure duration was not significantly different during the three treatments. Key wordsAnaesthetics, intravenous; methohexitone. Electroconvulsive therapy.Methohexitone has been described as the drug of choice for anaesthesia for electroconvulsive therapy (ECT).'.* However, 40-60% patients experience pain during its injection into a vein on the dorsum of the hand prior to surgery,'-5 but the incidence in patients who have anaesthesia for ECT is not known. Repeated anaesthesia is required for ECT treatment, and anticipation of pain on injection may be very distressing for patients, a pain which could be reduced if lignocaine is given with, or prior to, methohexitone.'~6The present study was designed to determine the incidence of pain during injection of methohexitone prior to ECT treatment, and to assess whether it could be reduced by the use of lignocaine. A bilateral generalised convulsion must be produced during ECT if treatment is to be beneficial.' The use of lignocaine prior to ECT is usually avoided,x because it reduces seizure duration and renders treatment less effe~tive.~ The effect of lignocaine on seizure duration was therefore also recorded during the present study. MethodsThirty-five patients who had a course of bilateral ECT for treatment of depression were included in the study, which was approved by the Hospital Ethics Committee. Eight male and 27 female unpremedicated patients, aged 18-80 years and who weighed 43-90 kg, were studied. Patients gave informed verbal consent to participate, and none receiving treatment under the provisions of the Mental Health Act were involved.Patients were studied during three consecutive ECT treatments over a period of 10-14 days, but not during the first treatment, because seizure duration is often prolonged at this time.I0 Concurrent medication was not altered during the study. Anaesthesia was induced with one of three regimens, the order of which was randomly selected for each patient. All subjects experienced all three methods of induction of anaesthesia on separate occasions.Methohexitone only. Venepuncture was performed using a 23-gauge butterfly needle inserted into a small vein on the dorsum of the hand. One millilitre 0.9% saline was injected, and venou...

Current Perspectives on Pain upon Injection of Drugs

“…[68][69][70]102 If necessary, the drug product labeling may include a recommendation that a specific vehicle or local anesthetic or other protective agent be administered concurrently with the drug. 40,41,43,45,47,57,66,[76][77][78][79]82,83,[87][88][89]91,[93][94][95]100,101,107,108,116,121 The addition of compounds such as procaine or lidocaine to an injection will block the transmission and perception of pain (see mediation of pain) associated with injection via their action on sodium receptors. However, the question that needs to be addressed is whether this is a desirable to utilize this multiple drug approach for long-term therapy.…”

Comparison of propofol and a propofol-methohexitone mixture for induction of day-case anaesthesia

“…Compared with the results of previous studies (table 4), the propofol-methohexitone mixture compared favourably with methohexitone alone in all aspects except the incidence of apnoea on induction, which was higher with the drug combination, presumably reflecting the addition of propofol. In this study both groups had a lower incidence of pain on injection (because of the addition of lignocaine [12,13]), and of postoperative nausea and vomiting than described previously.…”

Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy?

“…Two clinical trials found that using lidocaine at doses ranging from 50–200 mg shortened the length of seizure duration, suggesting a dose-dependent effect 7 8 . Observational studies using doses below 50 mg have found no effect on the length of seizure duration 4 9 . Nevertheless, lidocaine provides certain benefits for clinicians.…”