- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03057704
Comparison of Two Techniques of IV Lidocaine on Propofol Injection Pain
Comparison of Two Techniques of Administering IV Lidocaine in Reducing Propofol Injection Pain
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The investigators expect that tourniquet lidocaine is superior to straight non-tourniquet lidocaine in reducing propofol injection pain. The investigators also wanted to determine the association of tourniquet duration on reduction of pain with propofol administration. Small studies indicate that 60 seconds of tourniquet lidocaine is superior to 30 seconds or less of tourniquet duration or mixed lidocaine/propofol for injection. The investigators suspect many clinicians do not use the 60-second tourniquet technique due to the extra time involved but hypothesize that a more practical application by applying the tourniquet as soon as the patient is positioned on the operating table will not only be more widely adopted by clinicians as it does not cause delay but also provide the necessary amount of time for benefit from the tourniquet. The investigators also wanted to record the time from tourniquet application to start of propofol administration, which the investigators predict would be at least 60 seconds to see if there is a correlation between duration of venous stasis of IV lidocaine and pain benefit.
Methods and Measures
Design This was conducted as a randomized controlled trial of two methods of administering lidocaine prior to propofol injection.
Setting The study setting was located within North Carolina Baptist Health, an academic medical center, in the Endoscopy Suite or Outpatient Surgery Center where subjects were scheduled to receive propofol as part of their sedation or anesthetic.
Sample Size The investigators estimated that 25 subjects in each of the two groups was required to test the hypothesis based on prior studies.
Interventions and Interactions
The investigators used two groups:
- Group 1: 50mg of 2% lidocaine given just prior to the propofol dose through the IV line.
- Group 2: 50mg of 2% lidocaine given IV with venous occlusion applied when the patient is positioned on the operating room table and timed until the onset of propofol administration. The tourniquet the investigators used was a Quick Release tourniquet applied to the forearm 10cm distal to the elbow joint in the tourniquet group. Venous stasis was confirmed with cessation of flow from hanging IV fluid.
For both groups, no premedication was given, which is the normal practice for these procedures. Study procedures involved placing a 20 gauge intravenous (IV) catheter in a vein distal to the mid forearm. Venous occlusion was achieved by either a latex free tourniquet or McKesson Quick Release tourniquet applied to the forearm 10cm distal to the elbow joint. Tourniquet pressure was somewhat variable but sufficient to cause venous stasis as confirmed by no flow of hanging IV fluid. Injections were delivered at roughly 1 ml/sec.
Schedule of events in the study (all performed by 1 of the 2 investigators:
Day of procedure: holding area
- Consent subject for study participation
- Randomly assign patient to one of two groups
Day of procedure: procedure area
-Accompany subject to the operating or procedure room, perform protocol from the group to which the subjects were assigned, while noting outcome measures such as self-described discomfort and observer graded discomfort
Day of procedure: recovery area
-Revisit subject in recovery 30 minutes after their procedure to determine post-procedure recall of discomfort
- Post-study period
- Analyze data
Analytical Plan The investigators will analyze results initially using descriptive statistics. Comparison between groups was done using chi square tests for proportions, and t-tests or ANOVA procedures for continuous variables. Regression analysis was performed to identify independent outcome predictors. Other inferential statistical analysis was conducted as appropriate.
Informed Consent One of the two investigators obtained signed informed consent from each subject. This was performed in the holding room prior to the procedure since most subjects had their pre-procedure examination performed in the holding room and were not seen prior to the day of their procedure.
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
-
-
North Carolina
-
Winston-Salem, North Carolina, United States, 27612
- North Carolina Baptist Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Any subject at North Carolina Baptist Hospital scheduled for a procedure in which they will receive propofol for sedation or anesthesia and will not be receiving any other medications prior to the propofol injection.
- Cases must be schedule to have a duration less than 60 minutes.
Exclusion Criteria:
- Subjects are excluded if they cannot verbalize a rating of pain
- Subjects are excluded if they require intravenous medications prior to the study period
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Intravenous lidocaine: flushed
Lidocaine injection flushed
|
The investigator administers IV lidocaine and flushes it into the subject prior to administering propofol.
Other Names:
|
Experimental: Intravenous lidocaine: tourniquet
Lidocaine injection tourniquet
|
Intravenous lidocaine: tourniquet
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Patient Expression of Pain
Time Frame: During injection at beginning of study; lasts 10 seconds one time only
|
Patient's verbal rating of pain during injection (see link to study protocol) We used a Verbal Rating Scale from the patient that self-described discomfort level during injection using question: How would you rate your pain using None, Mild, Moderate, Severe and record it on this 4-point scale:
|
During injection at beginning of study; lasts 10 seconds one time only
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Subject's Recall of Injection Discomfort
Time Frame: This occurs 30 minutes after the subject's procedure is finished in the recovery room; lasts 30 seconds one time only
|
Investigator asks patient if they recall discomfort during injection after the procedure. Patient's verbal rating and recall of pain during injection. We used a Verbal Rating Scale from the patient that self-described discomfort level during injection using question: How would you rate your pain using None, Mild, Moderate, Severe and record it on this 4-point scale:
|
This occurs 30 minutes after the subject's procedure is finished in the recovery room; lasts 30 seconds one time only
|
Investigators Rating of Patient Discomfort
Time Frame: During injection at beginning of study period; lasts 10 seconds one time only
|
Investigator rates patient's nonverbal display of discomfort. Investigator Assessments: Induction Discomfort Scale (during injection and within 5 seconds after injection)
|
During injection at beginning of study period; lasts 10 seconds one time only
|
Collaborators and Investigators
Investigators
- Principal Investigator: Timothy N Harwood, MD, Wake Forest University Health Sciences
- Study Director: Patrick Grace, MD, Wake Forest University Health Sciences
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Arrhythmia Agents
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Sensory System Agents
- Anesthetics
- Membrane Transport Modulators
- Anesthetics, Local
- Voltage-Gated Sodium Channel Blockers
- Sodium Channel Blockers
- Lidocaine
Other Study ID Numbers
- IRB00040756
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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