Şennur UZUN, Ayşe Heves KARAGÖZ, Emine Arzu KÖSE, Özgür CANBAY, Saadet ÖZGEN

Propofol enjeksiyon ağrısını önlemede % 5 dekstroz ile dilüe edilen deksmedetomidinin etkisi

Amaç: Propofol hızlı etki ve derlenme süresi ile anestezi indüksiyonunda sık kullanılan intravenöz anesteziktir ancak en büyük dezavantajı enjeksiyonunun ağrılı olmasıdır. Hasta memnuniyetini doğrudan etkileyen bir faktör olduğundan önlenmesi için değişik yöntemler kullanılmıştır. Bu çalışmada, dekstroz ile dilüe edilen deksmedetomidinin propofol enjeksiyon ağrısını azaltmadaki etkilerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: ASA I-II, elektif genel anestezi alacak 96 hasta çalışmaya dahil edilerek Deksmedetomidin-Dekstroz Grubu ve Dekstroz Grubu olmak üzere ikiye ayrıldı. 1 dakika süreyle 70 mmHg turnike uygulanan kola, deksmedetomidin (0.2 mg kg-1, 5 mL, % 5 dekstroz ile tamamlanmış) veya 5 mL % 5 dekstroz verildi. Turnike indirildikten sonra toplam propofolün (2.5 mg kg-1) dörtte biri 5 saniyede enjekte edildi. Ağrının değerlendirilmesi 4 puanlı ağrı skoru kullanılarak yapıldı. Ki-kare testi ağrı parametresinin karşılaştırılması için kullanıldı, p< 0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Deksmedetomidin-Dekstroz Grubu’nda 33 hastada, Dekstroz Grubu’nda 23 hastada propofol ile enjeksiyon ağrısı olmamıştır (p= 0.005). Dekstroz Grubu’nda hafif (skor 1) ve orta (skor 2) derecede ağrı duyan hasta sayısı diğer gruptan istatistiksel olarak fazladır (p< 0.05). Sonuç: Propofol enjeksiyon ağrısını önlemede dekstroz ile dilüe edilen deksmedetomidinin periferik antinosiseptif etkisi nedeniyle % 5 dekstrozdan daha etkili bir yöntem olabileceğini saptadık.

The effect of dexmedetomidine diluted in 5 % dextrose to prevent propofol injection pain

Aim: Propofol is the most preferred intravenous anesthetic agent with a rapid onset and recovery but the worst disadvantage is its injection pain. Many methods were used to prevent injection pain since it influences the patient satisfaction. In this study, it was aimed to investigate the effects of dexmedetomidine and dextrose in alleviating propofol injection pain. Materials-Method: ASA I-II, 96 patients sheduled for elective surgery were included into the study and were divided into two groups as dexmedetomidine-dextrose and dextrose. Tourniquet was left inflated for 1 min at 70 mmHg and dexmedetomidine (0.2 mg kg-1, 5 ml, diluted in 5 % dextrose) or 5 ml 5 % dextrose were injected. After the release of the tourniquet, 5 ml of total propofol dose (2.5 mg kg-1) was injected in 5 seconds. Pain assesment was performed by questioning the patient (using 4 point (0-1-2-3) scale). Two groups were compared statistically by Chi-square test, p< 0.05 was considered as statistically significant. Results: There were no injection pain in 33 patients in group dexmedetomidine-dextrose, and 23 patients in group dextrose (P=0.005). The number of patients with mild (score 1) and moderate pain (score 2) score in dextrose group was statistically higher than the dexmedetomidine-dextrose group (p< 0.05). Conclusion: As a result, dexmedetomidine diluted in 5 % dextrose, due to its peripheral antinociceptive effects, is found to be more effective than 5 % dextrose to prevent propofol injection pain.

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1. Agarwal A, Raza M, Dhiraaj S et al. Pain during injection of propofol: the effect of prior administration of butorphanol. Anesth Analg 2004; 99: 117-9.
2. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg 1996; 82: 469-71.
3. Scott RP, Saunders DA, Norman J. Propofol: Clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492-4.
4. King SY, Davis FM, Wells JE, Murchison DJ, Pryor PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992; 74: 246-9.
5. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963-9.
6. Memiş D, Turan A, Karamanlıoğlu B, Süt N, Pamukçu Z. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg 2002; 95: 606-8.
7. Aşik I, Yörükoğlu D, Gülay I, Tulunay M. Pain on injection of propofol: comparison of metoprolol with lidocaine. Eur J Anaesthesiol 2003; 20: 487-9.
8. Cheong MA, Kim KS, Choi WJ. Ephedrine reduces the pain from propofol injection. Anesth Analg 2002; 95: 1293-6.
9. Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol 2005; 18: 412-8.
10. Memis D, Turan A, Kaya G, Karamanlioglu B, Seker S. Preventing pain on injection of rocuronium: two doses of dexmedetomidine. Can J Anaesth 2005; 52: 437-8.
11. Turan A, Memis D, Kaya G, Karamanlioglu B. The prevention of pain from injection of propofol by dexmedetomidine and comparison with lidocaine. Can J Anaesth 2005; 52: 548-9.
12. Dalle C, Schneider M, Clergue F, Bretton C, Jirounek P. Inhibition of the I(h) current in isolated peripheral nevre: a novel mode of peripheral antinociception? Muscle Nerve 2001; 24: 254-61.
13. Guneli E, Karabay Yavasoglu NU, Apaydin S, Uyar M, Uyar M. Analysis of the antinociceptive effect of systemic administration of tramadol and dexmedetomidine combination on rat models of acute and neuropathic pain. Pharmacol Biochem Behav. 2007; 88: 9-17.
14. Poree LR, Guo TZ, Kingery WS, Maze M. The analgesic potency of dexmedetomidine is enhanced after nerve injury: a possible role for peripheral alpha2-adrenoceptors, Anesth Analg 1998; 87: 941–8.
15. Stokes DN, Robson N, Hutton P. Effect of diluting propofol on the incidence of pain on injection and venous sequelae. Br J Anaesth 1989; 62: 202-3.
16. Doenicke AW, Roizen MF, Rau J, Kellermann W, Babl J. Reducing pain during propofol injection: the role of the solvent. Anesth Analg 1996; 82: 472-4.
17. Ayoğlu H, Altunkaya H, Ozer Y, Yapakçi O, Cukdar G, Ozkoçak I. Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? Eur J Anaesthesiol 2007; 24: 541-5.
18. Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991; 67: 281-4.
19. Nonaka A, Tamaki F, Sugawara T, Oguchi T, Kashimoto S, Kumazawa T. Premixing of 5% dextrose in Ringer’s acetate solution with propofol reduces incidence and severity of pain on propofol injection. Masui 1999; 48: 862–7.
20. Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998; 53: 468-76.
21. Grauers A, Liljeroth E, Akeson J. Propofol infusion rate does not affect local pain on injection. Acta Anaesthesiol Scand 2002; 46: 361-3.
22. Graven-Nielsen T, Arendt-Nielsen L. Gender differences in response to pain. Ugeskr Laeger 2007; 169: 2425-7.
23. Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med 2005; 2: 137-45.
24. Fillingim RB, Gear RW. Sex differences in opioid analgesia: clinical and experimental findings. Eur J Pain 2004; 8: 413-25.
25. Klement W, Arndt JO. Pain on i. Br J Anaesth 1991; 66: 189-95.
26. Rau J, Roizen MF, Doenicke AW, O’Connor MF, Strohschneider U. Propofol in an emulsion of long- and medium-chain triglycerides: the effect on pain. Anesth Analg 2001; 93: 382-4.