Pretreatment with Topical 60% Lidocaine Tape Reduces Pain on Injection of Propofol

Yokota, Shuichi; Komatsu, Toru; Komura, Yoko; Nishiwaki, Kimitoshi; Kimura, Tetsunori; Hosoda, Renko; Shimada, Yasuhiro

doi:10.1213/00000539-199709000-00034

Cited by 25 publications

(12 citation statements)

References 19 publications

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“…Scott et al 9 reported the incidence of pain of various severity levels as 25% to 74% and the incidence of moderate or severe pain as 32% to 52%. King et al 2 reported the incidence of pain as 73%; Ho et al, 11 as 91.7%; and Yokota et al, 17 as 87%. In our study, the incidence of pain was 66.7%.…”

Section: Discussionmentioning

confidence: 97%

“…Various methods, such as the administration of opioids 4,16 ; local anesthetics 9,10 ; cold saline and topical nitroglycerin 7,8 ; cooling the propofol to 4ЊC 6,8 ; ketamine 7 ; antiemetics 3 ; coinduction with thiopental sodium, tourniquet application, or lidocaine-prilocaine cream 8 ; topical lidocaine 17 ; aspirin 18 ; and nonsteroidal anti-inflammatory drugs 12 have been tried. However, Picard and Tramer 8 emphasized that the best method for controlling pain due to propofol injection has not been determined.…”

Section: Discussionmentioning

confidence: 99%

“…Yokota et al 17 reported that applying tape containing 60% lidocaine to the injection site decreased the incidence of pain from 87% to 33%, and that mixing 40 mg of lidocaine with propofol decreased the incidence of pain to 30%. We believe that using a mixture of propofol plus lidocaine is simple and inexpensive.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients

Madenoğlu

Yildiz

Doğru

et al. 2003

Current Therapeutic Research

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Background: The incidence of pain due to propofol injection is high, but the most efficacious method of preventing this pain has not been identified.Objective: The aim of this study was to investigate the efficacy of lidocaine, at different doses and schedules, on propofol injection pain. Methods:In this open-label study, conducted at the Department of Anaesthesiology, Erciyes University Gevher Nesibe Hospital (Kayseri, Turkey), patients with American Society of Anesthesiologists Patient Acuity Classification I-II (ASA I-II) (ie, patients with absent [I] or mild [II] underlying systemic disease) aged 18 to 60 years undergoing various types of surgery were eligible. Patients were randomized to 1 of 4 treatment groups: group 1 received propofol; group 2, a combination of propofol plus lidocaine 10 mg; group 3, lidocaine 10 mg 30 seconds before propofol administration; and group 4, lidocaine 1 mg/kg 30 seconds before propofol administration (all drugs were administered intravenously). After cessation of the standard replacement fluid infusion (isotonic saline), propofol was given at a rate of 2 mL every 5 seconds until a dose of 2 mg/kg was reached. The patients were asked to rate their pain according to the following scale: 0 ϭ none, 1 ϭ mild, 2 ϭ moderate, and 3 ϭ severe.Results: A total of 120 patients (61 men, 59 women; mean [SD] age, 38.7 [8.9] years) were enrolled in the study (n ϭ 30 patients in each group). The incidence of injection pain in groups 2 and 4 was significantly lower than that in groups 1 and 3 (all P Ͻ 0.05), but no significant difference in the incidence of pain was found between groups 1 and 3. The incidence of pain in group 2 was significantly lower than that in group 4 (P Ͻ 0.05).Conclusions: In this study population, the addition of 10 mg of lidocaine to propofol 2 mg/kg, or the administration of 1 mg/kg of lidocaine 30 seconds before the administration of propofol 2 mg/kg, effectively decreased pain caused by propofol injection. Furthermore, a lower dose of lidocaine could be used. Based on our results, we suggest mixing propofol with 10 mg of lidocaine to decrease pain due to propofol injection during anesthesia induction. (Curr Ther Res Clin Exp. 2003;64:310-316)

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients

Madenoğlu

Yildiz

Doğru

et al. 2003

Current Therapeutic Research

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“…It has been reported that lidocaine tape provides effective skin analgesia, minimizing the pain caused by percutaneous cannulation, stellate ganglion block, and propofol injection. [1][2][3] Eutectic mixture of local analgesics has also been used to alleviate cutaneous pain in children and adults. 4 However, for optimal analgesic effects, the correct amount of the drug must be applied and the skin should be properly dressed for an effective absorption.…”

Section: Skin Analgesia With Lidocaine Tape Prior To Epidural Blockadementioning

confidence: 99%

Skin analgesia with lidocaine tape prior to epidural blockade

Sobue¹,

Tsuda²,

Yumoto³

et al. 2003

Can J Anesth/J Can Anesth

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To the Editor: Racemic bupivacaine, when injected intravascularly, is associated with serious cardiac complications 1 such as ventricular fibrillation resistant to successful resuscitation. No such serious outcome was reported hitherto with levobupivacaine. The present case reports the accidental intravascular injection of a combination of levobupivacaine and lidocaine used for axillary brachial plexus blockade.A 35-yr-old patient was admitted to the hospital for orthopedic surgery. Following premedication with midazolam (4 mg) and placement of all monitors, he received an axillary plexus block by the transarterial approach using a mixture of lidocaine 2% (20 mL) and levobupivacaine 0.75% (20 mL). Twenty-five millilitres of the local anesthetic mixture was deposited posterior and 15 mL anterior to the axillary artery. Briefly after deposition and without showing signs of light central nervous system (CNS) toxicity (lightheadedness, tinnitus, metallic taste), the patient exhibited three interrupted episodes of tonic-clonic seizures, each lasting for about three seconds and eventually resulting in unconsciousness. The patient's heart rate (HR) showed a sinus tachycardia of 160 beats·min -1 , the blood pressure (BP) increased to 180/120 mmHg and the SPO 2 decreased to 40% within one minute. For seizure control, the patient was given 5 mg of midazolam and 100 mg of propofol iv. Following mask ventilation with 100% oxygen, he was intubated and brought to the postanesthesia care unit. His vital signs stabilized within 30 min (BP 103/74, HR 84, SPO 2 97%) without further pharmacologic support and he was extubated. Two hours after extubation, he was alert and oriented and discharged to home. The patient did not show signs of sensory and motor blockade.A recent case report of an accidental intravascular injection following epidural anesthesia with 19 mL of levobupivacaine 0.75% resulted in only minor CNS side effects (drowsiness, slurred speech) and, most importantly, no cardiac sequelae. 2 Plasma levels were not taken until 14 min after epidural injection, still they revealed a toxic range of levobupivaciane that, most likely, was substantially higher immediately after its intravascular administration. Though the severity of side effects remains unknown had racemic bupivacaine been administered in this patient, previous reports hint at a more serious outcome after racemic bupivacaine 0.75%. 1 Similarly, no cardiac effects other than a sinus tachycardia occurred in this young and otherwise healthy patient.It appears that levobupivacaine is a safer drug than racemic bupivacaine, still vigilance and the laws of regional anesthesia (slow and intermittent injections, frequent aspirations) need to be practiced to take advantage of levobupivacaine's wider margin of safety. Skin analgesia with lidocaine tape prior to epidural blockadeTo the Editor: Lidocaine tape (Penles®, Japan Lederle, Tokyo, Japan) is a self-adhesive poultice for local anesthesia containing 18 mg of lidocaine at a concentration of 60% in a 30.5 × 50.0 mm po...

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“…For reducing the pain arising from propofol, a wide range of pharmacologic and non-pharmacologic approaches have been attempted. Adding lidocaine to propofol, adjusting pH of propofol, giving alfentanyl, remifentanyl, ketamine, metoclopramide, nafamostat, granisetron, oral clonidyn, cold saline solution, ketorolac, thiopental, magnesium sulphate, ephedrine prior to injection; applying nitroglycerin to skin, applying EMLA or 60% lidocaine tape can be counted among the pharmacologic approaches [4,5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of hemodynamic response for intubation and propofol pain caused by lidocaine administration with infusion and tourniquet

Deniz¹,

Alparslan²,

Ak³

et al. 2017

Med-Science

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Propofol is one of the most widely used i.v. anesthetic agent. Nevertheless, pain following i.v. administration of propofol is an important problem in anesthesia induction. A wide range of studies have been performed related to lidocaine effects on propofol injection pain and hemodynamic response to intubation. However, effect of both situations are seldomly studied in the literature. In our study we compare lidocaine effects on propofol injection pain and hemodynamic response to intubation which is given by infusion or under tourniquet as i.v. bolus. 70 patients attended to the study are separated randomly into two groups of 35 patients. Prior to induction, lidocaine has been infused with infusion pump as to be completed in 2 minutes with concentration of 2%, total dosed 1mg/kg in infusion group (Group I, n=35). In this group, after half of the total lidocaine dose is infused (1st minute), anesthesia induction has been started by giving 40 mg propofol of 1% in 10 seconds with infusion pump. In tourniquet group (Group T, n=35) prior to induction 1mg/kg lidocaine has been given as bolus by applying tourniquet with 70 mm/Hg pressure to the arm that is established vascular access and tourniquet has been remained for 60 seconds. After opening the tourniquet, induction has been started by giving 40 mg propofol of 1% in 10 seconds with infusion pump. During induction, patient"s consciousness was evaluated by questioning his/her name and age after administering 1/4 (VRS0), 1/2 (VRS1), and 3/4 (VRS2) of total propofol dose. Confused patients were eliminated and the sense of pain caused by propofol was evaluated in study patients. The results were recorded according to four-point categorical verbal rating scale (VRS). For groups, the pulse rates and mean arterial pressures before lidocaine administration (T0), after lidocaine (T1), immediately after intubation (T2) and 10th minute after intubation (T3) were recorded. No differences detected among the groups with regards to demographic data and side effects. (p>0.05). No significant differences statically detected when comparing the heart rate (HR), mean arterial pressure (MAP) and pain scores of groups for all times (p>0.05). It is concluded that administering lidocaine by infusion technic may be an alternative method for tourniquet method on suppressing hemodynamic response related to tracheal intubation and on preventing injection pain related to propofol.

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Pretreatment with Topical 60% Lidocaine Tape Reduces Pain on Injection of Propofol

Cited by 25 publications

References 19 publications

Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients

Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients

Skin analgesia with lidocaine tape prior to epidural blockade

Comparison of hemodynamic response for intubation and propofol pain caused by lidocaine administration with infusion and tourniquet

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