预先口服对乙酰氨基酚可减少丙泊酚注射痛：随机安慰剂对照试验
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Premedication with oral paracetamol for reduction of propofol injection pain: a randomized placebo-controlled trial
背景与目的
比较预先口服两种不同剂量乙酰氨基酚预防丙泊酚静脉注射痛的效果。
方 法
本试验为一项双盲随机对照试验。在该试验中，诱导前1小时予计划静脉注射丙泊酚行全麻诱导的患者分别口服安慰剂、500 mg或1000 mg对乙酰氨基酚（分别为p500和p1000）。丙泊酚给药剂量为2mg/kg，注射速率为600 ml/h。当注射剂量占全部剂量的1/4后，暂停注射泵，要求患者使用从0到10的言语数字评分(VNRs)来评估注射部位的疼痛程度。
结 果
本研究共纳入324例患者。P 500组和P 1000组(中间VNRs[四分位数范围]分别=2[0-3]和4[2-5])患者疼痛强度均低于安慰剂组 (8 [7–10]; P < 0.001)。p1000组的疼痛发生率（70.4%）低于p500和安慰剂组（分别为86.1和99.1%；p<0.001）。P 1000组轻度(VNRs 1-3)、中度(VNRs 4-6)和重度疼痛(VNRs 7-10)的发生率分别为47.2%、23.2%和0%，P 500组分别为28.7%、50%和7.4%，安慰剂组分别为0、22.2%和76.9%(P<0.001)。3组耐受性相似。
结 论
口服对乙酰氨基酚可以减少丙泊酚静脉注射时的疼痛。在当前的实践中，为了避免患者对丙泊酚注射痛感到担忧，这种耐受性好的、可获得的和廉价的治疗方法似乎是一种理想的选择。
原始文献摘要
Nimmaanrat S, Jongjidpranitarn M, Prathep S, et al. Premedication with oral paracetamol for reduction of propofol injection pain: a randomized placebo-controlled trial.[J] .BMC Anesthesiol, 2019, 19: 100.
Background: To compare the effect of premedication with 2 different doses of oral paracetamol to prevent pain at propofol intravenous injection.
Methods: We conducted a double-blind randomized controlled trial in which patients scheduled for induction of general anesthesia with intravenous propofol received either a placebo, 500 mg or 1000 mg of oral paracetamol (P500 and P1000, respectively) 1 h prior to induction. Two mg/kg of propofol was injected at a rate of 600 ml/hr. After 1/4 of the full dose had been injected, the syringe pump was paused, and patients were asked to rate pain at the injection site using a verbal numerical rating score (VNRS) from 0 to 10.
Results: Three hundred and twenty-four patients were included. Pain intensity was lower in both P500 and P1000 groups (median VNRS [interquartile range] = 2 [0–3] and 4 [2–5], respectively) than in the placebo group (8 [7–10]; P < 0.001)*. The rate of pain was lower in the P1000 group (70.4%) than in both the P500 and the placebo group
(86.1 and 99.1%, respectively; P < 0.001)*. The respective rates of mild (VNRS 1–3), moderate (VNRS 4–6) and severe pain (VNRS 7–10) were 47.2, 23.2 and 0% in the P1000 group, 28.7, 50 and 7.4% in the P500 group, and 0, 22.2 and 76.9% in the placebo group (P < 0.001* for between group comparisons). Tolerance was similar in the 3 groups.
Conclusions: A premedication with oral paracetamol can dose-dependently reduce pain at propofol intravenous injection. To avoid this common uncomfortable concern for the patients, this well-tolerated, available and cheap treatment appears as an option to be implemented in the current practice.
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贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙