DOI QR코드

DOI QR Code

Evaluation of efficacy of Valsalva maneuver for attenuating propofol injection pain: a prospective, randomized, single blind, placebo controlled study

  • Kumar, Sanjay (Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences) ;
  • Khuba, Sandeep (Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences) ;
  • Agarwal, Anil (Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences) ;
  • Gautam, Sujeet (Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences) ;
  • Yadav, Madhulika (Department of Dentistry, Government Medical College) ;
  • Dixit, Aanchal (Department of Anesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences)
  • 투고 : 2018.01.18
  • 심사 : 2018.05.23
  • 발행 : 2018.12.01

초록

Background: Pain on injection is a limitation with propofol use. The effect of the Valsalva maneuver on pain during propofol injection has not been studied. This maneuver reduces pain through the sinoaortic baroreceptor reflex arc and by distraction. We aimed to assess the efficacy of the Valsalva maneuver in reducing pain during propofol injection. Methods: Eighty American Society of Anesthesiologists class I adult patients undergoing general anesthesia were enrolled and divided into two groups of 40 each. Group I (Valsalva) patients blew into a sphygmomanometer tube raising the mercury column up to 30 mmHg for 20 seconds, while Group II (Control) patients did not. Anesthesia was induced with 1% propofol immediately afterwards. Pain was assessed on a 10-point visual analog scale (VAS), where 0 represented no pain, and 10, the worst imaginable pain, and a 4-point withdrawal response score, where 0 represented no pain, and 3, the worst imaginable pain. Scores were presented as median (interquartile range). Results: We analyzed the data of 70 patients. The incidence of pain was significantly lower in the Valsalva than in the control group (53% vs. 78%, P = 0.029). The withdrawal response score was significantly lower in the Valsalva group (1.00 [0.00-1.00] vs. 2.00 [2.00-3.00], P < 0.001). The VAS score was significantly lower in the Valsalva group (1.00 [0.00-4.00] vs. 7.00 [6.25-8.00], P < 0.001). Conclusions: A prior Valsalva maneuver is effective in attenuating injection pain due to propofol; it is advantageous in being a non-pharmacological, safe, easy, and time-effective technique.

키워드

참고문헌

  1. Kang JG, Lee SM, Lim SW, Chung IS, Hahm TS, Kim JK, et al. Correlation of AEP, BIS and OAA/S scores under stepwise sedation using propofol TCI in orthopedic patients undergoing total knee replacement arthroplasty under spinal anesthesia. Korean J Anesthesiol 2004; 46: 284-92. https://doi.org/10.4097/kjae.2004.46.3.284
  2. Shabana AM. Prevention of propofol injection pain, using lidocaine in a large volume does it make a difference? A prospective randomized controlled double blinded study. Egyptian J Anaesth 2013; 29: 291-4. https://doi.org/10.1016/j.egja.2013.04.003
  3. Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492-4. https://doi.org/10.1111/j.1365-2044.1988.tb06641.x
  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. https://doi.org/10.1213/00000539-199202000-00013
  5. McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia 1990; 45: 443-4. https://doi.org/10.1111/j.1365-2044.1990.tb14329.x
  6. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963-9. https://doi.org/10.1213/00000539-200004000-00035
  7. Gupta D, Agarwal A, Dhiraaj S, Tandon M, Kumar M, Singh RS, et al. An evaluation of efficacy of balloon inflation on venous cannulation pain in children: a prospective, randomized, controlled study. Anesth Analg 2006; 102: 1372-5. https://doi.org/10.1213/01.ane.0000205741.82299.d6
  8. Agarwal A, Sinha PK, Tandon M, Dhiraaj S, Singh U. Evaluating the efficacy of the valsalva maneuver on venous cannulation pain: a prospective, randomized study. Anesth Analg 2005; 101: 1230-2. https://doi.org/10.1213/01.ane.0000167270.15047.49
  9. Mohammadi SS, Pajand AG, Shoeibi G. Efficacy of the valsalva maneuver on needle projection pain and hemodynamic responses during spinal puncture. Int J Med Sci 2011; 8: 156-60. https://doi.org/10.7150/ijms.8.156
  10. McMurtry CM, Pillai Riddell R, Taddio A, Racine N, Asmundson GJ, Noel M, et al. Far from "just a poke": common painful needle procedures and the development of needle fear. Clin J Pain 2015; 31(10 Suppl): S3-11. https://doi.org/10.1097/AJP.0000000000000272
  11. Lee JR, Jung CW, Lee YH. Reduction of pain during induction with target-controlled propofol and remifentanil. Br J Anaesth 2007; 99: 876-80. https://doi.org/10.1093/bja/aem293
  12. Macario A, Weinger M, Truong P, Lee M. 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. https://doi.org/10.1213/00000539-199905000-00023
  13. Klimek L, Bergmann KC, Biedermann T, Bousquet J, Hellings P, Jung K, et al. Visual analogue scales (VAS): Measuring instruments for the documentation of symptoms and therapy monitoring in cases of allergic rhinitis in everyday health care: Position Paper of the German Society of Allergology (AeDA) and the German Society of Allergy and Clinical Immunology (DGAKI), ENT Section, in collaboration with the working group on Clinical Immunology, Allergology and Environmental Medicine of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNOKHC). Allergo J Int 2017; 26: 16-24.
  14. Englstrom JW, Martin JB. Disorders of the autonomic nervous system. In: Principles of Internal Medicine. Edited by Braunwald E, Fauci AS: New York, McGraw-Hill. 2001, pp 2416-21.
  15. Randich A, Maixner W. Interactions between cardiovascular and pain regulatory systems. Neurosci Biobehav Rev 1984; 8: 343-67. https://doi.org/10.1016/0149-7634(84)90057-5
  16. McCaul KD, Malott JM. Distraction and coping with pain. Psychol Bull 1984; 95: 516-33. https://doi.org/10.1037/0033-2909.95.3.516
  17. Cohen LL. Reducing infant immunization distress through distraction. Health Psychol 2002; 21: 207-11. https://doi.org/10.1037/0278-6133.21.2.207
  18. Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics 2008; 122 Suppl 3: S134-9. https://doi.org/10.1542/peds.2008-1055f
  19. Cohen LL, Bernard RS, Greco LA, McClellan CB. A child-focused intervention for coping with procedural pain: are parent and nurse coaches necessary? J Pediatr Psychol 2002; 27: 749-57. https://doi.org/10.1093/jpepsy/27.8.749
  20. Ong EL, Lim NL, Koay CK. Towards a pain-free venepuncture. Anaesthesia 2000; 55: 260-2. https://doi.org/10.1046/j.1365-2044.2000.01124.x

피인용 문헌

  1. A Comparative Study of Valsalva Maneuver, Lidocaine, and Valsalva Maneuvers with Administration of Lidocaine to Reduce the Pain Associated with Administration of Etomidate During General Anesthesia vol.11, pp.3, 2018, https://doi.org/10.5812/aapm.113408