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Hu Y, Li X, Liu J, Chen H, Zheng W, Zhang H, Wu M, Li C, Zhu X, Lou J, Yan P, Wu N, Liu X, Ma S, Wang X, Ding Y, Xuan C. Safety, pharmacokinetics and pharmacodynamics of a novel γ-aminobutyric acid (GABA) receptor potentiator, HSK3486, in Chinese patients with hepatic impairment. Ann Med 2022; 54:2769-2780. [PMID: 36217101 PMCID: PMC9559057 DOI: 10.1080/07853890.2022.2129433] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The primary objective of this study was to investigate if hepatic impairment alters the safety, pharmacokinetics, and pharmacodynamics of HSK3486. RESEARCH DESIGN AND METHODS This was a clinical trial of HSK3486 in subjects with normal hepatic function (n = 8), and mild (Child-Pugh A; n = 8), or moderate (Child-Pugh B; n = 8) hepatic impairment. Each subject received an IV bolus dose of 0.4 mg/kg HSK3486 for 1 min, immediately followed by a maintenance infusion of 0.4 mg/kg/h HSK3486 for 30 min. RESULTS In total, 24 subjects were enrolled and completed the study. HSK3486 was generally well tolerated by all subjects. There were no serious AEs and no deaths reported during the study. The incidence of AEs was numerically highest in subjects with moderate hepatic impairment. The exposure (AUC) of HSK3486 increased gradually with the decrease in hepatic function; however, degree of hepatic impairment had little effect on HSK3486 PD (MOAA/S and BIS). CONCLUSIONS Overall, there were no clinically relevant differences in HSK3486 exposure or PD in subjects with mild or moderate hepatic impairment compared to normal control. These data imply that HSK3486 dose adjustment is not warranted in subjects with mild or moderate hepatic impairment. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04145596).Key MessageHSK3486 at an IV bolus dose of 0.4 mg/kg and a maintenance infusion of 0.4 mg/kg/h was safe and well tolerated by all mild or moderate hepatic impairment subjects and normal hepatic function subjects.There were no clinically relevant differences in HSK3486 exposure or PD in subjects with mild or moderate hepatic impairment compared to subjects with normal hepatic function.HSK3486 dose adjustment is not required in subjects with mild or moderate hepatic impairment.
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Affiliation(s)
- Yue Hu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Xiaojiao Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Jingrui Liu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Hong Chen
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Wenbo Zheng
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Hong Zhang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Min Wu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Cuiyun Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Xiaoxue Zhu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Jinfeng Lou
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Pangke Yan
- Haisco Pharmaceutical Group, Sichuan, China
| | - Nan Wu
- Haisco Pharmaceutical Group, Sichuan, China
| | - Xiao Liu
- Haisco Pharmaceutical Group, Sichuan, China
| | - Shiping Ma
- Haisco Pharmaceutical Group, Sichuan, China
| | - Xu Wang
- Haisco Pharmaceutical Group, Sichuan, China
| | - Yanhua Ding
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Chengluan Xuan
- Department of Anesthesiology, First Hospital, Jilin University, Jilin, China
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Li X, Yang D, Li Q, Wang H, Wang M, Yan P, Wu N, Li F, Ma S, Ding Y, Liu J, Wang H. Safety, Pharmacokinetics, and Pharmacodynamics of a Single Bolus of the γ-aminobutyric Acid (GABA) Receptor Potentiator HSK3486 in Healthy Chinese Elderly and Non-elderly. Front Pharmacol 2021; 12:735700. [PMID: 34512361 PMCID: PMC8430033 DOI: 10.3389/fphar.2021.735700] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background: The present clinical trial investigated the potential influences of dosage and age on the pharmacokinetic properties and safety profile of HSK3486, and whether any adjustment in dosing regimen is necessary in elderly patients. Methods: Twenty-four elderly participants (65–73 years) were apportioned to three equal cohorts to receive a single IV bolus of 0.2, 0.3, and 0.4 mg/kg HSK3486, respectively. An additional control group comprised eight non-elderly participants (21–44 years), who each received a single IV bolus dose of 0.4 mg/kg. Safety was assessed throughout the study, and the clinical effects were assessed based on modified observer’s assessment of alertness/sedation and bispectral index (BIS) monitor. Pharmacokinetic parameters were calculated. Results: The rates of drug-related adverse reactions among the elderly groups were a little higher than that of the non-elderly, and were slightly higher in the elderly receiving 0.4 mg/kg compared with the elderly given lower doses. The pharmacokinetic characteristics of 0.4 mg/kg HSK3486 in the elderly and non-elderly were comparable. The time to recovery was similar in elderly 0.3 mg/kg, elderly 0.4 mg/kg and non-elderly 0.4 mg/kg groups. In the elderly 0.2 mg/kg group, the time to loss of consciousness was a little longer, and the time to recovery was shorter, relative to the other three groups. Conclusions: Administration of 0.3 mg/kg to the elderly and 0.4 mg/kg to the non-elderly were similarly efficacious. A dose of HSK3486 of 0.3 mg/kg may be chosen for clinical use in elderly patients.
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Affiliation(s)
- Xiaojiao Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Deming Yang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Qianqian Li
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Hong Wang
- Jilin Medical Products Administration, Jilin, China
| | - Meng Wang
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Pangke Yan
- Haisco Pharmaceutical Group, Chengdu, China
| | - Nan Wu
- Haisco Pharmaceutical Group, Chengdu, China
| | | | - Shiping Ma
- Haisco Pharmaceutical Group, Chengdu, China
| | - Yanhua Ding
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Jingrui Liu
- Phase I Clinical Trial Unit, First Hospital, Jilin University, Jilin, China
| | - Hushan Wang
- Department of Anesthesiology, First Hospital, Jilin University, Jilin, China
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Impact of the Timing of Rocuronium Injection after Propofol Administration on Temporal Summation of Pain in Gynecologic Laparoscopic Surgery: A Prospective and Controlled Study. Pain Res Manag 2020; 2020:6642460. [PMID: 33376568 PMCID: PMC7744223 DOI: 10.1155/2020/6642460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/19/2022]
Abstract
Purpose Temporal summation of pain, which is defined as the perception of greater pain evoked by repetitive painful stimuli, varies among individuals. This study aimed at determining the impact of the timing of rocuronium after induction with propofol on the temporal summation of pain. Methods One hundred patients aged 19–60 years underwent gynecologic laparoscopic surgery. Patients were randomly assigned to one of the two groups: group PRi received immediate injections of rocuronium after propofol administration and group PRd received rocuronium injections when the bispectral index score (BIS) decreased to <60 after propofol administration. The grade of rocuronium-induced withdrawal movement (RIWM) according to the timing of propofol injection, the incidence and severity of propofol injection pain (PIP), rescue analgesics, visual analog scale (VAS) score after surgery for postoperative pain, patient-controlled analgesia (PCA) opioid consumption, association between PIP and the grade of RIWM, and associations between PIP, the grade of RIWM, and postoperative pain outcomes were measured. Results The differences between the incidence and severity of PIP in the two groups were not significant. The grade of the RIWM in the PRd group was significantly reduced compared with the PRi group. Rescue analgesics, severity for postoperative pain, and PCA opioid consumption were not significant. Correlations between the incidence and severity of PIP and the grade of RIWM were weakly negative. Correlations between the grade of RIWM and pain outcomes were moderately positive, but correlations between the severity for PIP and the postoperative pain outcomes were negligible. Conclusion The timing of rocuronium administration after propofol injection played a role in reducing RIWM. The grade of RIWM was significantly related to pain outcomes compared with the severity of PIP. Therefore, delayed rocuronium injection after induction with propofol reduced temporal summation of pain.
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Ozgul U, Begeç Z, Erdogan MA, Aydogan MS, Sanli M, Çolak C, Durmus M. Effect of Alkalinisation of Lignocaine for Propofol Injection Pain: A Prospective, Randomised, Double-Blind Study. Anaesth Intensive Care 2019; 41:501-4. [DOI: 10.1177/0310057x1304100411] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- U. Ozgul
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
| | - Z. Begeç
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
| | - M. A. Erdogan
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
| | - M. S. Aydogan
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
| | - M. Sanli
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
| | - C. Çolak
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
- Department of Biostatistics
| | - M. Durmus
- Department of Anesthesiology and Reanimation, Inonu University, Malatya, Turkey
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Choi E, Kim D, Jeon Y. Comparative study between 2 different doses of pregabalin and lidocaine on pain following propofol injection: A double-blind, randomized clinical consort study. Medicine (Baltimore) 2016; 95:e5153. [PMID: 28002316 PMCID: PMC5181800 DOI: 10.1097/md.0000000000005153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Propofol, an intravenous anesthetic, often causes pain on injection, which can be very distressful to patients. We investigated the analgesic effect of pregabalin on pain following propofol injection, compared with lidocaine. METHODS In a randomized, double-blind, prospective trial, 120 patients were randomized into 3 groups of 40 each; who received oral placebo and intravenous lidocaine 40 mg with venous occlusion for 1 minute (group L, n = 40), oral pregabalin 75 mg and intravenous normal saline with venous occlusion for 1 minute (group LP, n = 40), and oral pregabalin 150 mg and intravenous normal saline with venous occlusion for 1 minute (group HP, n = 40) as pretreatment, followed by administration of 1% propofol 0.5 mg/kg. Pain intensity was measured on a 4-point scale (0 = no, 1 = mild, 2 = moderate, and 3 = severe pain). Any side effects associated with pretreatment substances were recorded during the first 24 hours after surgery. RESULTS A total of 120 patients completed this trial. Demographic data were similar between groups. The incidence of pain following propofol injection was significantly reduced in group HP (50%) and group L (55%) compared with group LP (92.5%) (P < 0.05, respectively). The incidences of moderate pain in group HP (12.5%) and group L (15%) were significantly decreased compared with group LP (37.5%; both, P < 0.05). There were no significant differences in the incidence of side effects such as headache and dizziness between groups. CONCLUSION Pretreatment with oral pregabalin 150 mg and intravenous lidocaine 40 mg with venous occlusion equally reduced pain from propofol injection.
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Affiliation(s)
- Eunkyung Choi
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital
| | - Donggyeong Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University Hospital
| | - Younghoon Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
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Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi J Anaesth 2011; 5:62-6. [PMID: 21655019 PMCID: PMC3101756 DOI: 10.4103/1658-354x.76509] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective: The purpose of this study was to compare etomidate-lipuro and propofol and 50%, (1:1) admixture of these agents at induction with special reference to injection pain, hemodynamic changes, and myoclonus. Methods: Ninety patients were assigned at random to three groups in which induction was performed with either etomidate-lipuro, propofol or etomidate-lipuro–propofol admixture. After monitorization with bispectral index (BIS) all agents were given with infusion with a perfuser at a constant rate of 200 ml/min till the BIS values decreased to 40. Blood pressure and heart rate were measured every 30 s at this period. Patients were asked for pain at the injection site and observed visually for myoclonus. The time BIS values decreased to 40 (BIS 40 time) and total amounts of induction doses were measured. Results: BIS 40 time measurements were P > E > PE (199.4 ± 40.9, 176.9 ± 31.6, 163.5 ± 20.6 s). The hemodynamic (systolic, diastolic and mean blood pressures, heart rate) changes were minimal in group PE than other two groups (P = 0.017). The intensity of myoclonus was graded as mild in 9, moderate in 12, and severe in 5 patients in the group E (76.3%). Myoclonus was not observed in group PE and group P. There were no injection pain in group PE as the incidence were (83.8%) in group P and in (63.2%) group E. Conclusion: Incidence of hemodynamic changes, myoclonus, and injection pain is significantly lower in group PE. BIS 40 times is least in group PE. We concluded that 1:1 admixture of etomidate-lipuro and propofol is a valuable agent for induction.
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Lidocaine Pretreatment With Tourniquet Versus Lidocaine-Propofol Admixture for Attenuating Propofol Injection Pain. Reg Anesth Pain Med 2011; 36:41-5. [DOI: 10.1097/aap.0b013e31820306da] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Varghese E, Krishna HM, Nittala A. Does the newer preparation of propofol, an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine? Paediatr Anaesth 2010; 20:338-42. [PMID: 20470337 DOI: 10.1111/j.1460-9592.2010.03272.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Injection pain during propofol administration can be particularly distressing in children. The newly available emulsion of propofol in medium and long chain triglycerides (LCT) is reported to cause less injection pain because of lower concentrations of free propofol. This study compared the incidence of injection pain during administration of propofol emulsion of LCT and propofol emulsion of medium and long chain triglycerides (MCT/LCT) both premixed with lignocaine in children. METHODS This prospective, randomized, double blind study was conducted after obtaining institutional ethics committee approval, parental consent and included 84 children aged 5-15 years. Preoperatively, an intravenous cannula was inserted in all children. four children were excluded. Those included, depending on the randomization, received 3 mg x kg(-1) of either propofol LCT or propofol MCT/LCT both premixed with lignocaine (0.1%). The incidence and intensity of injection pain was assessed. RESULTS Pain on injection of propofol LCT with lignocaine was observed in 16/40 children (40%), five of these children complained of severe pain. In comparison, 14/40 (35%) children complained of pain following propofol MCT/LCT premixed with lignocaine (P = 0.644), the intensity being severe in two children (P = 0.698). CONCLUSIONS Propofol MCT/LCT and propofol LCT premixed with lignocaine are both associated with pain on injection in children; the incidence and intensity of the injection pain are similar.
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Affiliation(s)
- Elsa Varghese
- Department of Anesthesiology, Kasturba Medical College & Hospital, Manipal, Karnataka, India
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Fujii Y, Itakura M. Pretreatment with flurbiprofen axetil, flurbiprofen axetil preceded by venous occlusion, and a mixture of flurbiprofen axetil and propofol in reducing pain on injection of propofol in adult Japanese surgical patients: a prospective, randomized, double-blind, placebo-controlled study. Clin Ther 2009; 31:721-7. [PMID: 19446145 DOI: 10.1016/j.clinthera.2009.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain on injection of propofol is a common clinical problem. Flurbiprofen axetil, an injectable prodrug of flurbiprofen, with or without venous occlusion has been reported to reduce this pain. A search of the existing literature did not identify comparative studies of 3 different techniques, including pretreatment with flurbiprofen axetil, flurbiprofen axetil preceded by venous occlusion, and mixture of propofol and flurbiprofen axetil, for reducing pain on injection of propofol. OBJECTIVE The aim of this study was to compare the effectiveness of these 3 different techniques of flurbiprofen axetil administration in reducing pain on injection of propofol. METHODS This prospective, randomized, doubleblind, placebo-controlled study was conducted at the Department of Anesthesiology, Ushiku Aiwa General Hospital, Ibaraki, Japan. Japanese elective surgical patients, aged 20 to 65 years, were enrolled and were randomly divided into 6 groups: the control group received placebo (saline) before administration of IV propofol 0.5 mg/kg; the flurbiprofen group was pretreated with IV flurbiprofen axetil 50 mg before injection of propofol 0.5 mg/kg; the tourniquet control group received placebo (saline) with a tourniquet for 2 minutes followed by administering propofol 0.5 mg/kg; the tourniquet flurbiprofen group was pretreated with flurbiprofen axetil 50 mg with a tourniquet for 2 minutes followed by administering propofol 0.5 mg/kg; the mixed control group was induced with a mixture of placebo (saline) and propofol 0.5 mg/kg; and the mixed flurbiprofen group was induced with a mixture of flurbiprofen axetil 50 mg and propofol 0.5 mg/kg. Immediately after administering propofol into the largest vein of the hand through a 20-gauge intravenous cannula, an investigator blinded to group assignment asked the patient to assess pain intensity at the injection site using a 4-point verbal rating scale: 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Adverse effects (AEs) at the injection site (pain, edema, wheal, or inflammation) were assessed by the investigator for 24 hours after surgery using spontaneous reporting and patient interview. RESULTS One hundred fifty-five patients were assessed for inclusion. A total of 150 patients (71 males, 79 females; mean [SD] age, 41 [10] years; mean [SD] height, 161 [9] cm; mean [SD] body weight, 58 [9] kg) were enrolled and completed the study. Each treatment group comprised 25 patients. No significant differences in the demographic characteristics were observed among the 6 groups. The overall incidence of pain on injection of propofol was 92% (23 of 25 patients) in the control group versus 60% (15/ 25) in the flurbiprofen group (P = 0.009); 84% (21/25) in the tourniquet control group versus 32% (8/25) in the tourniquet flurbiprofen group (P = 0.001); and 92% (23/25) in the mixed control group versus 80% (20/25) in the mixed flurbiprofen group (P = NS). The median pain score was significantly lower in the flurbiprofen group (1) compared with the control group (2) (P = 0.002); this score was significantly lower in the tourniquet flurbiprofen group (0) compared with the tourniquet control group (2) (P = 0.001); the score was comparable between the mixed control and mixed flurbiprofen groups (2 vs 2, respectively; P = NS). The incidence and severity of pain on injection of propofol were significantly less in the tourniquet flurbiprofen group compared with the flurbiprofen group (both, P < 0.05). No AEs at the injection site were observed or reported. CONCLUSION In this study of adult Japanese surgical patients, pretreatment with flurbiprofen axetil 50 mg preceded by venous occlusion was found to be more effective in reducing pain on injection of propofol than the other flurbiprofen axetil administration strategies tested.
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Affiliation(s)
- Yoshitaka Fujii
- First Department of Anesthesiology, Toho University School of Medicine, Ohta-ku, Tokyo, Japan.
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Kodaka M, Okuyama SI, Maeyama A, Koyama K, Miyao H. Evaluation of low-dose propofol preadministration to attenuate vascular pain during induction of anesthesia. J Clin Anesth 2007; 19:440-3. [DOI: 10.1016/j.jclinane.2007.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 03/19/2007] [Accepted: 03/27/2007] [Indexed: 10/22/2022]
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Aouad MT, Siddik-Sayyid SM, Al-Alami AA, Baraka AS. Multimodal Analgesia to Prevent Propofol-Induced Pain: Pretreatment with Remifentanil and Lidocaine Versus Remifentanil or Lidocaine Alone. Anesth Analg 2007; 104:1540-4, table of contents. [PMID: 17513655 DOI: 10.1213/01.ane.0000261520.34879.09] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Propofol is well-known for its pain on injection. Premixture with lidocaine or pretreatment with remifentanil reduces injection pain. A multimodal approach might offer additional mitigation of propofol injection pain. METHODS In a randomized, prospective, double-blind study of 156 patients, we compared the incidence and severity of propofol pain among three groups. Patients in the lidocaine group (n = 54) received 2% lidocaine premixed with propofol (40 mg lidocaine in 180 mg propofol). Patients in the remifentanil group (n = 50), received pretreatment with remifentanil 2 microg x kg(-1) IV over 30 s. Patients in the combination group (n = 52) received both lidocaine and remifentanil. RESULTS A significant decrease in the overall incidence of propofol pain at induction was achieved in the combination group (9.6%) compared with that in the remifentanil group (36%) and the lidocaine group (35%) (P = 0.003). The incidence of severe and moderate pain was also significantly different in the combination group (0%), compared with that in the remifentanil (18%) and lidocaine groups (12.9%) (P < 0.02). Similar, statistically significant differences among the three groups were achieved concerning recalled pain in the postanesthesia care unit. CONCLUSIONS The combination of two different analgesic modalities, remifentanil and lidocaine completely abolishes moderate and severe pain associated with propofol injection, and significantly reduces the incidence of mild pain when compared with each drug used alone.
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Affiliation(s)
- Marie T Aouad
- Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.
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Mallick A, Elliot SC, Krishnan K, Vucevic M. Lidocaine is more efficient than the choice of propofol formulations to reduce incidence of pain on induction. Eur J Anaesthesiol 2007; 24:403-7. [PMID: 17376253 DOI: 10.1017/s0265021506002298] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Propofol is associated with pain on injection. It is common practice to premix lidocaine with propofol prior to injection. Lipuro propofol, a propofol emulsified in medium- and long-chain triglycerides, has been shown to reduce the intensity of injection pain compared to Diprivan, although a number of studies report no reduction in overall incidence of pain. METHODS We conducted this randomized double-blind trial to determine the extent of further pain reduction by adding lidocaine to Lipuro propofol. A total of 328 ASA I-III patients were randomized to one of four groups to receive Diprivan propofol (Group DP), Lipuro propofol (Group LP), Diprivan with lidocaine (Group DL) and Lipuro propofol with lidocaine (Group LL). The drug mixture was administered at a constant rate of 400 mL h(-1) via a 20-G cannula into a dorsal hand vein. Pain was assessed during induction and upon patient recovery, using a 10-point visual analogue scale. RESULTS Both the incidence and severity of pain were found to be significantly lower with addition of lidocaine to Lipuro propofol (P < 0.0002) compared to Lipuro alone, Diprivan with or without the addition of lidocaine. CONCLUSION Lidocaine added to Lipuro propofol makes induction of anaesthesia less painful compared to Lipuro propofol alone or Diprivan with lidocaine.
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Affiliation(s)
- A Mallick
- Anaesthesia and Intensive Care Unit, Leeds General Infirmary, Leeds, UK.
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Kwak K, Kim J, Park S, Lim D, Kim S, Baek W, Jeon Y. Reduction of pain on injection of propofol: combination of pretreatment of remifentanil and premixture of lidocaine with propofol. Eur J Anaesthesiol 2007; 24:746-50. [PMID: 17261216 DOI: 10.1017/s026502150600233x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUNDS AND OBJECTIVE There is a high incidence of pain following intravenous injection of propofol, and many studies have been conducted to find a way of reducing this. The administration of lidocaine and, recently, remifentanil has also been used for this purpose, but it is only partially effective. Thus, the purpose of this study was to investigate the analgesic effect of a combination of pretreatment with remifentanil and premixture of lidocaine with propofol and to compare either treatment alone during propofol injection in dorsal hand-veins. METHODS In a prospective, randomized, double-blinded trial, we studied 141 adult patients scheduled for elective surgery. The combination of pretreatment of remifentanil (0.35 microg kg(-1) min(-1)) and a premixture of lidocaine with propofol (mixture of propofol 1% and lidocaine 1% in a 10:1 ratio) was compared with either treatment alone in the prevention of pain on propofol injection. Pain was assessed on a four-point scale (0=none, 1=mild, 2=moderate, 3=severe) during propofol injection. Patients in Group B received remifentanil (0.35 microg kg(-1) min(-1)) 30 s before the injection of propofol. RESULTS The reduction of pain on propofol injection was similar in both the remifentanil pretreatment and lidocaine premixture groups (62.2% vs. 62.2%). Combination therapy was associated with a higher incidence of patients without pain (91.3%) than either treatment alone (P<0.001). On analysing the injection pain scores, we found a significant reduction of the score in the remifentanil and lidocaine Group C compared with the lidocaine Group A (P<0.001) and the remifentanil Group B (P<0.001). CONCLUSIONS The combination of pretreatment of remifentanil and premixture of lidocaine with propofol was more effective in reducing the incidence of pain on injection of propofol than either treatment alone.
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Affiliation(s)
- K Kwak
- Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
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Bachmann-Mennenga B, Ohlmer A, Boedeker RH, Mann M, Mühlenbruch B, Heesen M. Preventing pain during injection of propofol: effects of a new emulsion with lidocaine addition. Eur J Anaesthesiol 2006; 24:33-8. [PMID: 16824248 DOI: 10.1017/s0265021506000974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2006] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies found that lidocaine addition to propofol long-chain triglyceride was associated with a lower incidence of injection pain than medium-chain triglyceride/long-chain triglyceride formulation, but the incidence was still high (31-40%). Our study investigated whether the incidence of injection pain could be further reduced by the addition of lidocaine (10 mg, 20:1) to propofol medium-chain triglyceride/long-chain triglyceride. METHODS In a randomized double-blind controlled trial 464 patients scheduled to undergo regional anaesthesia were assigned to receive one of the following four options: propofol medium-chain triglyceride/long-chain triglyceride + lidocaine, propofol long-chain triglyceride + lidocaine, propofol medium-chain triglyceride/long-chain triglyceride or propofol long-chain triglyceride. Propofol was injected to reach grade 3 of the Observer's Assessment of Alertness/Sedation scale. RESULTS Incidence of injection pain was 18% in the propofol medium-chain triglyceride/long-chain triglyceride + lidocaine group, 31% in the propofol long-chain triglyceride + lidocaine group, 47% in the propofol medium-chain triglyceride/long-chain triglyceride group and 60% in the long-chain triglyceride group. Propofol medium-chain triglyceride/long-chain triglyceride + lidocaine was associated with a statistically significant reduced incidence of injection pain compared with propofol long-chain triglyceride +lidocaine (P =0.0249, number needed to treat =7.7). CONCLUSIONS Premixing propofol medium-chain triglyceride/long-chain triglyceride with lidocaine is one of the most effective measures currently available to reduce the incidence of injection pain in sedated patients during regional anaesthesia.
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Suzuki H, Miyazaki H, Andoh T, Yamada Y. Propofol formulated with long-/medium-chain triglycerides reduces the pain of injection by target controlled infusion. Acta Anaesthesiol Scand 2006; 50:568-71. [PMID: 16643226 DOI: 10.1111/j.1399-6576.2006.00986.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Propofol is a widely used intravenous anesthetic although its injection pain is a common and unpleasant problem. Long-/medium-chain triglyceride (LCT/MCT) propofol has been introduced, as its low free propofol content is expected to reduce injection pain compared with LCT propofol. Target controlled infusion (TCI) differs from conventional induction in the initial infusion pattern. During induction using TCI, we investigated injection pain caused by two propofol solutions with different triglyceride compositions. METHODS Fifty patients, ASA I-II, with adequate communicative ability, were randomly assigned to two groups. TCI was conducted with Diprifusor for LCT and with BeComSim (custom-made software) for LCT/MCT. The target blood concentration was set at 4 microg/ml for both groups. At 30, 60, and 120 s after the infusion, patients were asked questions regarding the severity of pain on a 0-10 pain score. The total dose of propofol and the time required to induce anesthesia were also investigated. RESULTS The LCT/MCT propofol group had a larger number of pain-free patients and showed lower severity of pain than the LCT group [the number of pain-free patients being 11 and 3, respectively (P < 0.05), and median maximum pain being 0 and 4.5, respectively (P < 0.01)]. The dose and time required for induction were not significantly different between the groups (dose of 84 +/- 27 and 80 +/- 24 mg, respectively, and time of 119 +/- 60 and 107 +/- 55 s, respectively). CONCLUSION Our study showed that the frequency and severity of pain during TCI induction with propofol could be significantly reduced using LCT/MCT propofol rather than LCT propofol.
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Affiliation(s)
- H Suzuki
- Department of Anaesthesiology, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan
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Nyman Y, von Hofsten K, Georgiadi A, Eksborg S, Lönnqvist PA. Propofol injection pain in children: a prospective randomized double-blind trial of a new propofol formulation versus propofol with added lidocaine. Br J Anaesth 2005; 95:222-5. [PMID: 15894560 DOI: 10.1093/bja/aei156] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The incidence of pain on injection of propofol remains unacceptably high in children, despite various strategies to reduce it. A new drug formulation of propofol has, in adult studies, been reported to cause less injection pain compared with other propofol solutions. The aim of the present prospective randomized double-blind clinical trial was to compare the incidence of pain-free injection following the use of this new formulation with that following the use of propofol with added lidocaine in children undergoing day case surgery. METHODS Eighty-three children (age range 2-18 yr) were randomized to receive 3 mg kg(-1) of either Propofol-Lipuro (propofol dissolved in a mixture of medium- and long-chain triglycerides [MCT-LCT]; group pL, n=42) or Diprivan (propofol dissolved in long-chain triglycerides [LCT]) with added lidocaine (0.3 mg kg(-1)) (group pD, n=41). A specially trained nurse anaesthetist assessed the occurrence of injection pain using a four-graded pain scale. RESULTS Significantly fewer patients had an entirely pain-free propofol injection in group pL (33.3%) than in group pD (61.0%) (P=0.016). CONCLUSIONS A new MCT-LCT propofol formulation as a plain solution was associated with a higher incidence of injection pain than LCT propofol with added lidocaine when used for induction of anaesthesia in children.
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Affiliation(s)
- Y Nyman
- Department of Paediatric Anaesthesia and Intensive Care, Astrid Lindgrens Children's Hospital, Karolinska Institutet, Stockholm, Sweden.
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Adam S, van Bommel J, Pelka M, Dirckx M, Jonsson D, Klein J. Propofol-induced injection pain: comparison of a modified propofol emulsion and standard propofol with premixed lidocaine. Anesth Analg 2005; 100:1858-1859. [PMID: 15920229 DOI: 10.1213/01.ane.0000151482.91599.cc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sigrid Adam
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands,
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Riker RR, Fraser GL. Adverse Events Associated with Sedatives, Analgesics, and Other Drugs That Provide Patient Comfort in the Intensive Care Unit. Pharmacotherapy 2005; 25:8S-18S. [PMID: 15899744 DOI: 10.1592/phco.2005.25.5_part_2.8s] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since the 2002 publication of multidisciplinary clinical practice guidelines for intensive care unit (ICU) sedation and analgesia, additional information regarding adverse drug events has been reported. Our understanding of the risks associated with these sedative and analgesic agents promises to improve outcomes by helping clinicians identify and respond to therapeutic misadventures sooner. This review focuses on many issues, including the potentially fatal consequences associated with the propofol infusion syndrome, the evolving understanding of propylene glycol intoxication associated with parenteral lorazepam, new data involving high-dose and long-term dexmedetomidine therapy, haloperidol- and methadone-related prolongation of QTc intervals on the electrocardiogram, adverse events associated with atypical antipsychotics, and the potential for nonsteroidal antiinflammatory drugs to interfere with bone healing.
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Affiliation(s)
- Richard R Riker
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Maine Medical Center, Portland, Maine 04102, USA
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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