Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000500004
Brazilian Journal of Anesthesiology
Scientific Article

Dor a injeção venosa de propofol em crianças: efeitos da adição de lidocaína e da inalação de óxido nitroso

Pain after propofol intravenous injection in children: effects of combined lidocaine and inhalational nitrous oxide

Artur Udelsmann; Waston V Silva; Virgínia Maia da Conceição; Rosa Inês Costa Pereira

http://dx.doi.org/10.1590/S0034-70942001000500004 Braz J Anesthesiol, vol.51, n5, p.394-400, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: O meio hospitalar tem inúmeros fatores de apreensão e medo para as crianças. Entre eles injeções venosas são um dos mais importantes, principalmente se dolorosas. Propofol tem sido largamente utilizado para a indução da anestesia, mas tem o inconveniente de causar dor à injeção. O objetivo deste estudo foi comparar dois métodos de analgesia para a injeção venosa de propofol em crianças. MÉTODO: Sessenta e nove crianças admitidas ao centro cirúrgico para procedimentos de rotina sob anestesia geral, previamente com uma via venosa instalada no dorso de uma das mãos, foram aleatoriamente divididas em quatro grupos. No grupo 1, as crianças inalaram previamente, durante 2 minutos, O2 e a indução foi feita somente com propofol. No grupo 2, inalaram O2 e a cada 90 mg de propofol foram acrescentados 10 mg de lidocaína na forma de solução a 1%. No grupo 3, as crianças inalaram N2O 66% e O2 33% e o propofol foi usado puro. No grupo 4, os dois métodos foram combinados: as crianças inalaram N2O 66% com O2 33% e a indução foi feita com propofol diluído com lidocaína. A dor à indução foi avaliada, assim como a freqüência cardíaca antes e após a injeção. RESULTADOS: O grupo 4 foi o único no qual não se observou alteração da freqüência cardíaca após a injeção de propofol. No grupo 1, as crianças apresentaram mais dor e no grupo 4 tiveram menos. No grupo 2, a analgesia não foi suficiente e no grupo 3 houve somente uma tendência estatística à analgesia. CONCLUSÕES: Nas condições deste estudo, a inalação prévia de N2O antes da injeção venosa de propofol associado à lidocaína mostrou ser o método de analgesia mais eficaz para a indução da anestesia geral com propofol em crianças.

Palavras-chave

ANESTÉSICOS, Inalatório, Local, HIPNÓTICOS, TÉCNICAS ANESTÉSICAS, Venosa

Abstract

BACKGROUND AND OBJECTIVES: Hospital settings are stressful and fearful for children. Intravenous injections are mostly feared, especially if painful. Propofol is widely used for anesthesia induction but has the disadvantage of pain. This study aimed to compare two analgesic methods for intravenous propofol injection in children. METHODS: Participated in this study 69 pediatric patients admitted for routine procedures under general anesthesia, with an intravenous line on the back of one hand, who were randomly allocated into four groups. Group 1 received previous inhalational O2 for 2 minutes and anesthesia was induced with propofol only. Group 2 inhaled O2 and to each 90 mg of propofol 10 mg of 1% lidocaine were added. Group 3 inhaled 66% N2O and 33% O2 and anesthesia was induced with propofol alone. Group 4 received a combination of both methods: children inhaled 66% N2O with 33% O2 and anesthesia was induced with propofol combined with lidocaine. Pain on induction and heart rate before and after injection were evaluated. RESULTS: Group 4 was the only one with no changes in heart rate after propofol injection. Group 1 had more pain on induction and group 4 had less. Analgesia was insufficient for group 2, and group 3 has only shown a statistical trend to analgesia. Conclusions: Dilution with lidocaine combined with N2O inhalation before intravenous propofol injection showed to be the most efficient method of analgesia for propofol induction in children.

Keywords

ANESTHETICS, Inhalational, Local, ANESTHETIC TECHNIQUES, Intravenous, HYPNOTICS

References

Weir PM, Munro HM, Reynolds PI. Propofol infusion and the incidence of emesis in pediatric outpatient strabismus surgery. Anesth Analg. 1993;76:760-764.

Martin TM, Nicolson SC, Bargas MS. Propofol anesthesia reduces emesis and airway obstruction in pediatric outpatients. Anesth Analg. 1993;76:144-148.

Beck GN, Masterson GR, Richards J. Comparison of intubation following propofol and alfentanil with intubation following thiopentone and suxamethonium. Anaesthesia. 1993;48:876-880.

Borgeat A, Wilder-Smith OHG, Saiah M. Subhypnotic doses of propofol relieve pruritus induced by epidural and intratechal morphine. Anesthesiology. 1992;76:510-512.

Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia. 1998;53:468-476.

Doenicke AW, Roizen MF, Rau J. Pharmacokimetics and pharmaodynamics of propofol in a new solvent.. Anesth Analg. 1997;85:1399-1403.

Valtonen M, Iisalo E, Kanto J. Comparison between propofol propofol and thiopentone for induction of anaesthesia in children. Anaesthesia. 1988;43:696-699.

Valtonen M, Iisalo E, Kanto J. Propofol as an induction agent in children: pain on injection and pharmacokinetics.. Acta Anaesthesiol Scand. 1989;33:152-155.

Lyons B, Lohan D, Flynn C. Modification of pain on injection of propofol. A comparison of pethidine and lignocaine. Anaesthesia. 1996;51:394-395.

Scott RPF, Saunders DA, Norman J. Propofol: clinical strategies for preventing pain on injection.. Anaesthesia. 1988;43:492-494.

Eriksson M, Englesson S, Niklasson F. Effect of lignocaine and pH on propofol-induced pain.. Br J Anaesth. 1997;78:502-506.

Tam CS, Khoo ST. Modulating effects of lignocaine on propofol.. Anaesth Int Care. 1995;23:154-157.

Helbo-Hansen S, Westergaard V, Krogh BL. The reduction of pain on injection of propofol: the effect of addition of lignocaine. Acta Anaesthesiol Scand. 1988;32:502-504.

Nathanson MH, Gajraj NM, Russel JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg. 1996;82:469-471.

Cameron E, Johnston G, Crofts S. The minimum effective dose of lignocaine to prevent injection pain due to propofol in children. Anaesthesia. 1992;47:604-606.

Gehan G, Karoubi P, Quinet F. Optimal dose of lignocaine for preventing pain on injection of propofol. Br J Anaesth. 1991;66:324-326.

Lee TW, Loewenthal AE, Strachan JA. Pain during the injection of propofol. The effect of prior administration of thiopentone.. Anaesthesia. 1994;49:817-818.

Haugen RD, Vaghadia H, Waters T. Thiopentone pretreatment for propofol injection pain in ambulatory patients.. Can J Anaesth. 1995;42:1108-1112.

Fletcher JE, Seavell CR, Bowen DJ. Pretreatment with alfentanil reduces pain caused by propofol.. Br J Anaesth. 1994;72:342-344.

Helmers JH, Kraaijenhagen RJ, Leeuwen LV. Reduction of pain on injection caused by propofol. Can J Anaesth. 1990;37:267-268.

Parbrook GD. The levels of nitrous oxide analgesia. Br J Anaesth. 1967;39:974-982.

Henderson JM, Spence DG, Komokar RN. Administration of nitrous oxide to pediatric patients provides analgesia for venous cannulation. Anesthesiology. 1990;72:269-271.

Udelsmann A, Bassanezi BSB, Corrêa CMO. Estudo comparativo entre a inalação de óxido nitroso e a aplicação tópica da mistura eutética de anestésicos locais na prevenção da dor da punção venosa em anestesia pediátrica.. Rev Bras Anestesiol. 1997;46:497-501.

Hannallah RS, Baker SB, Casey W. Propofol: effective dose and induction characteristics in unpremedicated children. Anesthesiology. 1991;74:217-219.

Fletcher GC, Gillespie JA, Davidson JA. The effect of temperature upon pain during injection of propofol. Anaesthesia. 1996;51:498-499.

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