Neostigmine是否能減少propofol注射痛？

Can Neostigmine Reduce Propofol Injection Pain?

背景：在文獻中neostigmine有周邊止痛之作用，我們把neostigmine靜脈留置1分鐘，用來檢驗它是否有此周邊止痛之作用以減少propofol注射痛。方法：利用雙盲方式，105位病患隨機分為三組。N組(n = 35)接受0.5 mg neostigmine 1 ml、L組(n = 35)接受2% lidocaine 1 ml、C 組(n = 35)接受normal saline 1 ml、靜脈留置1分鐘，做為propofol注射前之處理，以減少propofol注射痛。應用小兒科的T-connector放置於靜脈留置軟針口以便藥物注射，趕血後放上止血帶，注入要研究的藥物，靜脈留置1分鐘，然後釋放止血帶，注入propofol引導麻醉。每一種藥物注射後都評估其注射痛及其附作用。結果：propofol注射痛次數為normal saline (85％) >neostigmine (46％) >lidocaine (6％，P< 0.05)，propofol注射痛程度為normal saline (mean rank 76.81) > neostigmine (mean rank 50.42) > lidocaine (mean rank 34.2，P< 0.05)。結論：以靜脈留置1分鐘，0.5 mg neostigmine (1 ml)是有一些周邊止痛之作用可減少propofol注射痛，但比2％ lidocaine (1 ml)的周邊止痛作用還少。

Background: Neostigmine has been found to cause peripheral analgesia. We used venous retention technique to evaluate whether neostigmine displayed peripheral analgesic effect in reducing propofol injection pain. Methods: In a double blind fashion, 105 patients were randomly allocated to receive either 1 ml 0.5 mg neostigmine (Group N, n = 35), 1 ml 2% lidocaine (Group L, n = 35), or 1 ml normal saline (Group C, n = 35) as pretreatment to reduce pain on propofol injection. A pediatric T-connector linking with the i.v. catheter port was used for injection. Venous occlusion was made possible with a tourniquet before the intravenous administration of one of the three drugs. The tested drug was allowed to retain for one minute and then the tourniquet was released for propofol injection. Pain and side effect assessments were made after propofol injection. Results: The incidence of propofol injection pain was 85% in normal saline group, 46% in neostigmine group and 6% in lidocaine group (P< 0.05 among groups). The tested drugs arrayed in order of increasing magnitude of intensity of pain upon propofol injection were lidocaine (mean rank 34.20), neostigmine (mean rank 50.42) and normal saline (mean rank 76.81) in sequence (P< 0.05 among groups). Conclusions: With one-minute venous retention, 0.5 mg neostigmine (1 ml) could produce peripheral analgesia to some degree in reducing propofol injection pain. However, its analgesic effect was inferior to 1 ml of 2% lidocaine.