Does lidocaine more effectively prevent pain upon induction with propofol or etomidate when given preemptively than when mixed with the drug?
OBJECTIVE
To compare the efficacy of 2% lidocaine "timing" on alleviation of pain upon induction using propofol or etomidate.


METHODS
Prospective, randomized, double-blinded study.


METHODS
Academic teaching hospital.


METHODS
80 adult, ASA physical status I, II, and III patients scheduled for elective outpatient or inpatient surgery with an intravenous induction agent.


METHODS
Patients were randomly assigned to two groups. Group A received preemptive saline 4 mL and lidocaine 4 mL mixed with either propofol 20 mL (n = 20) or etomidate 20 mL (n = 20). Group B received preemptive lidocaine 4 mL and saline 4 mL mixed with either propofol 20 mL (n = 20) or etomidate 20 mL (n = 20). The 4 mL dose of preemptive drug dwelled for three minutes.


METHODS
The induction drug mixture was injected over 60 seconds while the patient was assessed for pain using a 4-point scale (0 = no pain,1 = mild, 2 = moderate, and 3 = severe).


RESULTS
Mean induction pain scores were 1.0 (SD = 0.89) for propofol and 0.9 (SD = 0.90) for etomidate, representing mild induction pain. Mean induction pain scores were 0.93 (SD = 0.92) for the simultaneous treatment groups and 0.98 (SD = 0.87) for the preemptive treatment groups. The observed differences in pain scores between the techniques were not statistically (P > 0.62) or clinically meaningful.


CONCLUSIONS
Alleviation and intensity of post-injection pain were not significantly influenced by the "timing" of administration of lidocaine 80 mg or by the specific induction drug. Pre-lidocaine and "simultaneous" lidocaine with either propofol or etomidate prevented severe pain in 95% of patients.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA. mbrock@wfubmc.edu
Margaret F
MF
Brock
Brian E
BE
Grace
Benjamin
B
Morley
Gabe
G
Hillegass
Timothy T
TT
Houle
Leanne
L
Groban
D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D017558:Elective Surgical Procedures / Q000379:methods; D005045:Etomidate / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D015742:Propofol; D005045:Etomidate