Median Effective Dose of Lidocaine for the Prevention of Pain Caused by the Injection of Propofol Formulated with Medium- and Long-Chain Triglycerides Based on Lean Body Weight

• Published in: Pain medicine (Malden, Mass.) Mass.), 2021-06, Vol.22 (6), p.1246-1252
• Main Authors: Tian, Shunping, Zhang, Dongsheng, Zhou, Wei, Tan, Chao, Shan, Qing, Ma, Rongrong, Xing, Zhi, Sui, Wei, Zhang, Zhuan
• Format: Article
• Language: English
• Subjects: Acute pain; Anesthesia; Anesthetics, Intravenous; Anesthetics, Local; Body Weight; Complications and side effects; Dosage and administration; Double-Blind Method; Elective surgery; Health aspects; Humans; Injection; Injections; Intravenous administration; Lidocaine; Pain; Pain - drug therapy; Pain - prevention & control; Patients; Prevention; Propofol; Propofol - adverse effects; Prospective Studies; Side effects; Surgery; Triglycerides
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnaa316

Abstract Objective To determine the median effective dose (ED50) of prophylactic intravenous lidocaine for the prevention of propofol medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion injection pain. Design Prospective trial, Dixon up-and-down sequential method. Setting Operating room of a single hospital. Patients Thirty patients aged 18–65 years with American Society of Anesthesiologists (ASA) status I or II who were scheduled for elective surgery under general anesthesia (GA) were included. Interventions The initial dose of prophylactic lidocaine before propofol MCT/LCT emulsion injection was set at 0.5 mg/kg lean body weight (LBW). The lidocaine dose was adjusted according to the degree of patients’ injection pain using the Dixon up-and-down sequential method. Measurements The ED50 and 95% confidence intervals (CIs) of lidocaine were calculated using the Dixon–Massey formula. Vital signs and adverse effects were recorded. In the postanesthesia care unit (PACU), patients were asked if they recalled feeling any injection pain with visual analog scale (VAS) evaluation. Results The ED50 of lidocaine for the prevention of propofol MCT/LCT emulsion injection pain was 0.306 mg/kg LBW (95% CI, 0.262–0.357 mg/kg LBW). No adverse reactions to lidocaine occurred. In the PACU, 90.9% of patients who experienced injection pain recalled this pain (VAS score, 2.8±1.8). Conclusions Prophylactic intravenous lidocaine (0.306 mg/kg LBW) effectively prevented propofol MCT/LCT emulsion injection pain in 50% of patients scheduled for elective surgery under GA with no adverse reaction occurring.