Comparison Between Intravenous Nalbuphine and Lidocaine in Reducing Propofol-Induced Injection Pain During Gastroscopy: A Randomized Controlled Trial

Abstract

Introduction Intravenous propofol anesthesia is widely used in painless endoscopy. However, propofol injection pain is a common adverse effect. This study investigated the effects of nalbuphine and lidocaine in reducing propofol-induced injection pain. Methods In this double-blind, randomized study, 330 patients were randomly divided into three groups by using a random number table: the nalbuphine group (N), lidocaine group (L), and control group (C). The N, L, and C groups received either 0.1 mg/kg nalbuphine, 0.5 mg/kg lidocaine, or an equivalent volume of normal saline, respectively, as pretreatment drug. Then propofol was manually injected. The primary outcome of this study was the incidence of propofol-induced injection pain, and secondary outcomes included the severity of propofol-induced injection pain, vital signs, and adverse events, including hypotension, bradycardia (< 50 beats/min), hypoxemia (SpO 2 < 90%), drowsiness, physical movement, and cough. Results The percentages of patients with propofol injection pain were higher in group C than in group N and group L (64, 34, and 27%, respectively, p < 0.05). The percentage of patients with severe pain after propofol injection was significantly higher in group C than in group N and group L (12, 1, and 0%, respectively, p < 0.05). The doses of propofol in group C and group L were significantly higher than that in group N. More patients suffered hypoxemia in group N than in group C and group L. Then, less patients got physical movement and cough in group N. Conclusions Pretreatment with nalbuphine 0.1 mg/kg was effective in reducing propofol-induced injection pain and propofol consumption. Propofol combined with nalbuphine can be safely and effectively used during gastroscopy. Trial Registration Chinese Clinical Trial Registry; ChiCTR1900025438.

Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Abortion or Curettage: A Prospective, Double-Blinded, Randomized and Placebo-Controlled Clinical Trial

“…Premedication with lidocaine 0.5 mg/kg before the injection of propofol reduced the incidence of PIP significantly, which was consistent with previous study. 21 , 36 A dosage of 40 mg lidocaine is an appropriate dosage to alleviate PIP within the same vein through a local anesthetic effect. Lidocaine reduces PIP through a central analgesic effect and a local anesthetic effect when the dosage reaches 1.5 mg/kg.…”

“…[1][2][3] To reduce the incidence of PIP, many techniques have been developed, including pre-treatment or mixed use with medium-chain and long-chain triglycerides, 4 pre-treatment or mixed use with lidocaine, [5][6][7][8][9] nonsteroidal anti-inflammatory drugs, 10 magnesium sulfate, 6,11 dexmedetomidine, 12 opioids, [13][14][15][16] or ketamine. 11,17 Although these strategies relieved PIP in varying degrees, the adverse event of these drugs such as emergence agitation, 18 laryngospasm, 19 pulmonary embolism, 20 gastrointestinal ulcer, 10 lengthy onset 21 or tinnitus and dizziness 22 limit their widespread clinical use. More patients complained of tinnitus or dizziness after the injection of lidocaine, 22 and the addition of lidocaine may disrupt the stability of propofol emulsions and may cause pulmonary embolism.…”

“…The incidence of adverse event (hypoxemia, chin lifting, physical movement and cough) in group Remi were lower than that in group NS and group Lido, which was in consistent with previous results that the adverse event was positively correlated with the dosages of propofol. 21 There were some limitations. First, our study was only conducted in single center.…”

Pharmacokinetic comparison of nalbuphine with single injection and patient‐controlled analgesia mimic method in healthy Chinese volunteers

“…Nalbuphine is an opioid analgesic that was first manufactured in the 1970s and has been used to induce analgesia, similar to other opioids 1–3 . As a “neutral” mu (μ) receptor antagonist, nalbuphine induces various opioid‐related side effects, including pruritus, respiratory depression and urinary retention at low dose 4 .…”

The Appropriate Dose of Remimazolam Combined with Remifentanil in Anesthesia for Gastroscopy

“…The main narcotic drugs used in painless gastroscopy are propofol, midazolam and adjuvant opioids. However, each drug has its advantages and disadvantages [ 4,5 ]. Among them, propofol has been the most preferred drug for general sedation due to its excellent sedative properties and a short terminal half-life.…”