A comparison of metoclopramide and lidocaine for preventing pain on injection of diazepam.
We compared the ability of metoclopramide with IV lidocaine pretreatment to abolish pain from a diazepam injection. In a randomized, prospective, double-blinded, placebo-controlled clinical trial, 159 patients (ASA physical status I and II), aged 20-70 yr old, were allocated to one of three groups. Placebo and study drugs were injected IV immediately before 0.1 mg/kg of diazepam into a dorsal hand vein. Patients in Groups 1, 2, and 3 received 2 mL of placebo, 2 mL of lidocaine 1%, and 2 mL of metoclopramide (10 mg), respectively. The patient's response was graded using a 4-point scale. Any score other than 0 represented pain on injection. We observed that the incidence of pain on diazepam injection was 83% in the placebo group, which was decreased to 70% and 39% in patients pretreated with metoclopramide and lidocaine, respectively. Although there was no significant difference in the incidence of pain in Groups 1 and 3 (P > 0.05), Group 3 showed significantly less patients with severe pain scores than Group 1 as diazepam was injected (P < 0.000). Group 2 showed a significantly less frequent incidence of pain than the saline (P < 0.000) and the metoclopramide (P < 0.002) groups as diazepam was injected. The intensity of pain in Group 2 was significantly less than Group 3 (P = 0.012). The intensity of diazepam injection pain was intense with placebo as compared with other groups (P < 0.000). Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative for painful injections.


CONCLUSIONS
Metoclopramide, rather than lidocaine pretreatment, may be a reasonable analgesic alternative to decrease pain from a diazepam injection, especially when there is a medical condition in which lidocaine should be used very cautiously.
Majedi
Hossein
H
Department of Anesthesiology, Babol University of Medical Sciences, Babol, Iran. majedi@hbi.or.ir
Rabiee
Mozaffar
M
Khan
Zahid Hussain
ZH
Hassannasab
Bahman
B
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D003975:Diazepam / Q000008:administration & dosage / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D008012:Lidocaine; D008787:Metoclopramide; D003975:Diazepam