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Epidural anesthesia with lidocaine reduces propofol injection pain

[L'anesthésie péridurale avec lidocaïne réduit la douleur provoquée par l'injection de propofol]

Tatsusuke Yoshikawa, MD PhD^*,,, Zen'ichiro Wajima, MD PhD, Tetsuo Inoue , MD PhD, Akira Ogura , MD PhD and Ryo Ogawa , MD PhD

^* From the Department of Anaesthesia, Hakujikai Memorial Hospital, Tokyo, the
Department of Anaesthesia, Chiba Hokusoh Hospital, Chiba, the
Department of Anaesthesiology, Tokyo Jikeikai Medical School, Tokyo, and the
Department of Anaesthesiology, Main Hospital, Nippon Medical School, Tokyo, Japan.

Address correspondence to: Dr. T. Yoshikawa, 5-11-1 Shikahama, Adachi-ku, Tokyo 123-0864, Japan. Phone: +81-3-3899-1311, ext. 2116; Fax: +81-3-3855-2851; E-mail: FZN03121{at}nifty.ne.jp

Purpose: To determine whether epidural lidocaine reduces the severity of propofol injection pain compared with iv lidocaine.

Methods: A prospective, randomized double-blind clinical study was conducted in 120 female patients scheduled for elective gynecological laparotomy. A lumbar epidural catheter and an iv catheter placed in the cephalic vein of the non-dominant hand were used in all patients. Patients of the control group (Group C) were given epidural normal saline followed by iv normal saline then iv propofol. Patients of Group E were given epidural 2% lidocaine (0.08 mL•cm^–1) followed by iv normal saline and then propofol. Patients of Group V were given epidural normal saline followed by iv 2% lidocaine (0.05 mL•kg^–1) then propofol. Pain was scored as no pain=0, minimal pain=1, moderate pain=2, severe pain=3.

Results: The pain scores, in group E; 1 (0–2) and group V; 2 (0–2), were significantly lower than in group C; 2 (1–3); median (25^th–75^th percentile) (P <0.001). There was no difference in pain score between groups E and V. The plasma lidocaine concentration 15 min after epidural lidocaine was 2.74 ± 0.54 µg•mL^–1, compared with 1.54 ± 0.31 µg•mL^–1 at three minutes after iv lidocaine.

Conclusion: Epidural and iv lidocaine equally reduced the severity of propofol injection pain despite higher lidocaine plasma concentrations in epidurally administered lidocaine.