Efficacy of lidocaine on preventing incidence and severity of pain associated with propofol using in pediatric patients: A PRISMA-compliant meta-analysis of randomized controlled trials

Bing-Chen Lang, Chun-Song Yang, Ling-Li Zhang, Wen-Sheng Zhang, Yu-Zhi Fu, Bing-Chen Lang, Chun-Song Yang, Ling-Li Zhang, Wen-Sheng Zhang, Yu-Zhi Fu

Abstract

Background: Propofol injection pain was considered as one conundrum during clinical anesthesia. The systematic review about the effect of lidocaine in reducing injection pain among children has not been established. The aim of the study was to systematically evaluate the efficacy and safety of such intervention.

Methods: The literature search was performed from the inception to the May 31, 2016 in PubMed, Ovid EMBASE, and Cochrane database. All randomized controlled trials that using lidocaine for propofol injection pain in children were enrolled. The primary outcome included the incidence of injection pain and the incidence of propofol injection pain in different degrees. The data were combined to calculate the relative ratio and relevant 95% confidence interval. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement.

Results: Data from the included 11 studies indicated that the incidence of injection pain was lower in lidocaine group than the incidence in saline control group and in propofol lipuro (medium- and long-chain triglycerides) group (pain occurrence: 22.1% in lidocaine vs 66.8% in saline, RR with 95% 0.34 [0.26, 0.43], I = 38%; 30.5% in lidocaine vs 46.9% in propofol lipuro, RR with 95% 0.68 [0.46, 1.00], I = 9%). There was no difference between lidocaine and ketamine/alfentanil both in reducing pain occurrence and in reducing pain severity (pain occurrence: 29.7% in lidocaine vs 25.8% in ketamine, RR with 95% 1.47 [0.16, 13.43], I = 94%; 31.0% in lidocaine vs 30.7% in alfentanil, RR with 95% 1.01 [0.69, 1.46], I = 11%). And the reported side effects revealed that the safety of lidocaine in pediatric patients was acceptable.

Conclusion: Compared with ketamine and alfentanil, lidocaine would be served as one more effective treatment in consideration of its well-matched efficacy, acceptable accessibility, and reasonable safety. However, more high-quality evidences in pediatric patients are necessary.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart of literature screening and the selection process.
Figure 2
Figure 2
Risk of bias assessment of included studies.
Figure 3
Figure 3
Effect of lidocaine versus saline control in reducing the incidence of propofol injection pain.
Figure 4
Figure 4
Effect of lidocaine versus ketamine in reducing the incidence of propofol injection pain.
Figure 5
Figure 5
Effect of lidocaine versus alfentanil in reducing the incidence of propofol injection pain.
Figure 6
Figure 6
Effect of lidocaine versus propofol lipuro (MCT/LCT) in reducing the incidence of propofol injection pain. MCT/LCT = medium- and long-chain triglycerides.
Figure 7
Figure 7
The incidence of severe pain in group lidocaine versus group saline control.
Figure 8
Figure 8
The incidence of moderate pain in group lidocaine versus group saline control.
Figure 9
Figure 9
The incidence of slight pain in group lidocaine versus group saline control.
Figure 10
Figure 10
The incidence of the severe pain in group lidocaine versus group ketamine.
Figure 11
Figure 11
The incidence of moderate pain in group lidocaine versus group ketamine.
Figure 12
Figure 12
The incidence of the severe pain in group lidocaine versus group alfentanil.
Figure 13
Figure 13
The incidence of moderate pain in group lidocaine versus group alfentanil.
Figure 14
Figure 14
The incidence of slight pain in group lidocaine versus group alfentanil.

References

    1. Morton NS, Johnston G, White M, et al. Propofol in paediatric anaesthesia. Paediatr Anaesth 1992;2:89–97.
    1. McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia 1990;45:443–4.
    1. Nyman Y, Von Hofsten K, Palm C, et al. Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. Br J Anaesth 2006;97:536–9.
    1. Lembert N, Wodey E, Geslot D, et al. Prevention of pain on injection with propofol in children: comparison of nitrous oxide with lidocaine. Ann Fr Anesth Reanim 2002;21:263–70.
    1. Zashedi H, Nikooseresht M, Seifrabie M. Prevention of propofol injection pain with small-dose ketamine. Middle East J Anesthesiol 2009;20:401.
    1. Iyilikci L, Balkan BK, Gokel E, et al. The effects of alfentanil or remifentanil pretreatment on propofol injection pain. J Clin Anesth 2004;16:499–502.
    1. Suzuki H, Miyazaki H, Andoh T, et al. Propofol formulated with long-/medium-chain triglycerides reduces the pain of injection by target controlled infusion. Acta Anaesthesiol Scand 2006;50:568–71.
    1. Liljeroth E, Akeson J. Less local pain on intravenous infusion of a new propofol emulsion. Acta Anaesthesiol Scand 2005;49:248–51.
    1. Gajraj NM, Nathanson MH. Preventing pain during injection of propofol: the optimal dose of lidocaine. J Clin Anesth 1996;8:575–7.
    1. Helbo-Hansen S, Westergaard V, Krogh BL, et al. The reduction of pain on injection of propofol: the effect of addition of lignocaine. Acta Anaesthesiol Scand 1988;32:502–4. 32.
    1. Euasobhon, Dej-Arkom S, Siriussawakul A, et al. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev 2016;18:CD007874.
    1. Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000;90:963–9.
    1. Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ 2011;342:d1110.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses. The PRISMA statement. BMJ 2009;21:b2535.
    1. Higgins JP, Altman DG, Gøtzsche PC, et al. Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
    1. Wiley Online Library, Higgins JP, Green S. Assessing risk of bias studies. Cochrane Handbook for Systematic Reviews of Interventions 2008;187–241.
    1. Hiller A, Saarnnaa L. Injection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children. Acta Anaesthesiol Scand 1992;36:564–8.
    1. Rahman Al-Refai A, Al-Mujadi H, Petrovaivanova M, et al. Prevention of pain on injection of propofol: a comparison of remifentanil with alfentanil in children. Minerva Anestesiol 2007;73:219–23.
    1. Rochette A, Hocquet AF, Dadure C, et al. Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study. Br J Anaesth 2008;101:390–4.
    1. Barbi E, Marchetti F, Gerarduzzi T, et al. Pretreatment with intravenous ketamine reduces propofol injection pain. Paediatr Anaesth 2003;13:764–8.
    1. Bilotta F, Ferri F, Soriano SG, et al. Lidocaine pretreatment for the prevention of propofol-induced transient motor disturbances in children during anesthesia induction: a randomized controlled trial in children undergoing invasive hematologic procedures. Paediatr Anaesth 2006;16:1232–7.
    1. Kwak HJ, Min SK, Kim JS, et al. Prevention of propofol-induced pain in children: combination of alfentanil and lidocaine vs alfentanil or lidocaine alone. Br J Anaesth 2009;103:410–2.
    1. Borazan H, Sahin O, Kececioglu A, et al. Prevention of propofol injection pain in children: a comparison of pretreatment with tramadol and propofol-lidocaine mixture. Int J Med Sci 2012;9:492–7.
    1. Depue K, Christopher NC, Raed M, et al. Efficacy of intravenous lidocaine to reduce pain and distress associated with propofol infusion in pediatric patients during procedural sedation. Pediatr Emerg Care 2013;29:13–6.
    1. Kaabachi O, Chettaoui O, Ouezini R, et al. A ketamine-propofol admixture does not reduce the pain on injection compared with a lidocaine-propofol admixture. Paediatr Anaesth 2007;17:734–7.
    1. Beyaz SG, T Fek A, Tokgöz O. The effect of propofol lipuro with and without lidocaine on injection pain in children. Niger J Clin Pract 2011;14:60–4.
    1. Nyman Y, von Hofsten K, Georgiadi A, et al. Propofol injection pain in children: a prospective randomized double-blind trial of a new propofol formulation versus propofol with added lidocaine. Br J Anaesth 2005;95:222–5.
    1. Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999;88:1085–91.
    1. Soltész S, Silomon M, Gräf G, et al. Effect of a 0.5% dilution of propofol on pain on injection during induction of anesthesia in children. Anesthesiology 2007;106:80–4.
    1. Huang CL, Wang YP, Cheng YJ, et al. The effect of carrier intravenous fluid speed on the injection pain of propofol. Anaesth Analg 1995;81:1087–8.
    1. Zhou Y, Yang J, Liu J, et al. Efficacy comparison of the novel water-soluble propofol prodrug HX0969w and fospropofol in mice and rats. Br J Anaesth 2013;115: 825-324.

Source: PubMed

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