Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults

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Abstract

Background Pain on propofol injection is an untoward effect and this condition can reduce patient satisfaction. Intravenous lidocaine injection hasbeen commonly used to attenuate pain on propofol injection. Although many studies have reported that lidocaine was effective inreducing the incidence and severity of pain, nevertheless, no systematic review focusing on lidocaine for preventing high-intensity painhas been published.Objectives The objective of this review was to determine the efficacy and adverse effects of lidocaine in preventing high-intensity pain on propofolinjection.Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 10), Ovid MEDLINE (1950 To October2014), Ovid EMBASE (1988 to October 2014), LILACS (1992 to October 2014) and searched reference lists of articles.We reran the search in November 2015. We found 11potential studies of interest, those studies were added to the list of 'Studiesawaiting classification' and will be fully incorporated into the formal review findings when we update the review.Selection criteria We included randomized controlled trials (RCTs) using intravenous lidocaine injection as an intervention to decrease pain on propofolinjection in adults. We excluded studies without a placebo or control group. Data collection and analysis We collected selected studies with relevant criteria. We identified risk of bias in five domains according to the following criteria:random sequence generation, allocation concealment, adequacy of blinding, completeness of outcome data and selective reporting.Weperformed meta-analysis by direct comparisons of intervention versus control.We estimated the summary odds ratios (ORs) and 95%confidence intervals using the random-effects Mantel-Haenszel method in RevMan 5.3. We used the I2 statistic to assess statisticalheterogeneity.We assessed overall quality of evidence using the GRADE approach.Main results We included 87 studies, 84 of which (10,460 participants) were eligible for quantitative analysis in the review. All participants, aged13 years to 89 years, were American Society of Anesthesiologists (ASA) I-III patients undergoing elective surgery. Each study wasconducted in a single centre in high- , middle- and low-income countries worldwide. According to the risk of bias assessment, all exceptfive studies were identified as being of satisfactory methodological quality, allowing 84 studies to be combined in the meta-analysis.Five of the 84 studies were assessed as high risk of bias: one for participant and personnel blinding, one for incomplete outcome data,and three for other potential sources of bias.The overall incidence of pain and high-intensity pain following propofol injection in the control group were 64% (95% CI 60% to67.9%) and 38.1% (95% CI 33.4% to 43.1%), respectively while those in the lidocaine group were 30.2% (95% CI 26.7% to 33.7%)and 11.8%(95% CI 9.7%to 13.8%). Both lidocaine admixture and pretreatment were effective in reducing pain on propofol injection(lidocaine admixture OR 0.19, 95% CI 0.15 to 0.25, 31 studies, 4927 participants, high-quality evidence; lidocaine pretreatment OR0.13, 95% CI 0.10 to 0.18, 43 RCTs, 4028 participants, high-quality evidence). Similarly, lidocaine administration could considerablydecrease the incidence of pain when premixed with the propofol (OR 0.19, 95% CI 0.15 to 0.24, 36 studies, 5628 participants, highqualityevidence) or pretreated prior to propofol injection (OR 0.14, 95% CI 0.11 to 0.18, 52 studies, 4832 participants, high-qualityevidence). Adverse effects of lidocaine administration were rare. Thrombophlebitis was reported in only two studies (OR not estimated,low-quality evidence). No studies reported patient satisfaction.Authors' conclusions Overall, the quality of the evidence was high. Currently available data fromRCTs are sufficient to confirmthat both lidocaine admixtureand pretreatment were effective in reducing pain on propofol injection. Furthermore, there were no significant differences of effectbetween the two techniques.

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Euasobhon, P., Dej-arkom, S., Siriussawakul, A., Muangman, S., Sriraj, W., Pattanittum, P., & Lumbiganon, P. (2016). Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd. https://doi.org/10.1002/14651858.CD007874.pub2

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