Comparison of Pain on Injection of Etomidate versus Etomidate-Lipuro in Patients Undergoing Elective Orthopedic Surgery: A Double-Blind Randomized Clinical Trial
,
Abstract
Background: Etomidate is an efficient general anesthetic associated with injection pain. Etomidate-Lipuro is its lipid emulsion, suggested to have less adverse effects. We aim to compare the injection pain of etomidate vs. etomidate-lipuro.
Methods: This double-blind randomized clinical trial investigated 46 hands (23 patients) undergoing elective orthopedic surgery referring to our hospital from May to September 2017. For each patient, intravenous (IV) access was put on both hands, on one of which 2 ml of etomidate (drug A) and on the other one, 2 ml of etomidate-lipuro (drug B) were infused simultaneously. Pain scores were compared between drug types by the Wilcoxon signed-rank test using the SPSS software.
Results: Among 23 patients included in the study, 8 (34.8%) were female. Mean ± standard deviation (SD) of the patients’ age was
40.52 ± 13.07 years (range: 22-60 years). The type of drug injected to the right hand was drug A in 14 hands (60.9%) and drug B in 9 hands (39.1%). Mean ± SD of pain scores was 3.57 ± 3.30 for drug A (P < 0.001). The hand side (left/right) showed no significant effect on the pain scores (P = 0.535).
Conclusion: This randomized clinical trial used each person as his/her own control (left/right hands). Given the results, etomidate-lipuro showed significant superiority over etomidate regarding injection pain. In fact, most patients felt no pain, which suggests etomidate-Lipuro as an appropriate sedative.
References
1. Franks NP, Zecharia AY. Sleep and general anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2011;58(2):139-48.
2. Alwardt CM, Redford D, Larson DF. General anesthesia in cardiac surgery: a review of drugs and practices. The journal of extra-corporeal technology. 2005;37(2):227-35.
3. Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plastic and reconstructive surgery. 2013;132(3):675-84.
4. Canbay O, Celebi N, Arun O, Karagoz AH, Saricaoglu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. British journal of anaesthesia. 2008;100(1):95-8.
5. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. European journal of anaesthesiology. 2010;27(3):253-7.
6. Vanlersberghe C, Camu F. Etomidate and other non-barbiturates. Handbook of experimental pharmacology. 2008(182):267-82.
7. Song JC, Lu ZJ, Jiao YF, Yang B, Gao H, Zhang J, et al. Etomidate Anesthesia during ERCP Caused More Stable Haemodynamic Responses Compared with Propofol: A Randomized Clinical Trial. International journal of medical sciences. 2015;12(7):559-65.
8. Song J-C, Lu Z-J, Jiao Y-F, Yang B, Gao H, Zhang J, et al. Etomidate anesthesia during ERCP caused more stable haemodynamic responses compared with propofol: a randomized clinical trial. International journal of medical sciences. 2015;12(7):559.
9. Aggarwal S, Goyal VK, Chaturvedi SK, Mathur V, Baj B, Kumar A. A comparative study between propofol and etomidate in patients under general anesthesia. Brazilian journal of anesthesiology (Elsevier). 2016;66(3):237-41.
10. Shen X-C, Ao X, Cao Y, Lan L, Liu X-M, Sun W-J, et al. Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil. Medical science monitor: international medical journal of experimental and clinical research. 2015;21:1.
11. Ye L, Xiao X, Zhu L. The Comparison of Etomidate and Propofol Anesthesia in Patients Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2017;27(1):1-7.
12. Saliminia A, Azimaraghi O, Javadi A, Abdoulahpoor M, Movafegh A. [Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study]. Revista brasileira de anestesiologia. 2017;67(6):615-8.
13. Doenicke A, Roizen MF, Hoernecke R, Mayer M, Ostwald P, Foss J. Haemolysis after etomidate: comparison of propylene glycol and lipid formulations. British journal of anaesthesia. 1997;79(3):386-8.
14. Nyman Y, Von Hofsten K, Palm C, Eksborg S, Lonnqvist PA. Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. British journal of anaesthesia. 2006;97(4):536-9.
15. Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi J Anaesth. 2011;5(1):62-6.
16. Kwak K-H, Ha J, Kim Y, Jeon Y. Efficacy of combination intravenous lidocaine and dexamethasone on propofol injection pain: a randomized, double-blind, prospective study in adult Korean surgical patients. Clinical therapeutics. 2008;30(6):1113-9.
17. Azimaraghi O, Aghajani Y, Molaghadimi M, Khosravi M, Eslami K, Ghadimi F, et al. Ondansetron reducing pain on injection of etomidate: a controlled randomized study. Revista brasileira de anestesiologia. 2014;64(3):169-72.
18. Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi journal of anaesthesia. 2011;5(1):62.
19. Gultop F, Akkaya T, Bedirli N, Gumus H. Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate. Journal of anesthesia. 2010;24(2):300-2.
20. Choi JM, Choi IC, Jeong YB, Kim TH, Hahm KD. Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus. Journal of clinical anesthesia. 2008;20(8):601-4.
21. Nyman Y, Von Hofsten K, Ritzmo C, Eksborg S, Lönnqvist P. Effect of a small priming dose on myoclonic movements after intravenous anaesthesia induction with Etomidate-Lipuro in children. British journal of anaesthesia. 2011;107(2):225-8.
22. Kelsaka E, Karakaya D, Sarihasan B, Baris S. Remifentanil pretreatment reduces myoclonus after etomidate. Journal of clinical anesthesia. 2006;18(2):83-6.
23. Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. The American journal of emergency medicine. 2003;21(7):556-8.
24. Vanacker B, Wiebalck A, Van Aken H, Sermeus L, Bouillon R, Amery A. Quality of induction and adrenocortical function. A clinical comparison of Etomidate-Lipuro and Hypnomidate. Der Anaesthesist. 1993;42(2):81-9.
25. Zhang SS, Zhou C, Liu J, Kang Y, Zhang P, Zhang WS. [30% intralipid shortens the duration of anesthesia induced by etomidate in rats]. Sichuan da xue xue bao Yi xue ban = Journal of Sichuan University Medical science edition. 2013;44(3):402-4, 23.
26. Brock MF, Grace BE, Morley B, Hillegass G, Houle TT, Groban L. Does lidocaine more effectively prevent pain upon induction with propofol or etomidate when given preemptively than when mixed with the drug? Journal of clinical anesthesia. 2010;22(7):505-9.
27. Meera P, Olsen RW, Otis TS, Wallner M. Etomidate, propofol and the neurosteroid THDOC increase the GABA efficacy of recombinant α4β3δ and α4β3 GABA A receptors expressed in HEK cells. Neuropharmacology. 2009;56(1):155-60.
28. Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Annals of cardiac anaesthesia. 2015;18(2):172.
29. St Pierre M, Dunkel M, Rutherford A, Hering W. Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia. European journal of anaesthesiology. 2000;17(10):634-41.
30. Kaur S, Kataria AP, Kaur G, Kaur M, Attri JP, Mohan B. Comparison of Induction Characteristics of Propofol-Lipuro and Etomidate-Lipuro in Cardiac Patients in Non-cardiac Surgery. Int J Sci Stud. 2014;2(6):66-72.
1. Franks NP, Zecharia AY. Sleep and general anesthesia. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2011;58(2):139-48.
2. Alwardt CM, Redford D, Larson DF. General anesthesia in cardiac surgery: a review of drugs and practices. The journal of extra-corporeal technology. 2005;37(2):227-35.
3. Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plastic and reconstructive surgery. 2013;132(3):675-84.
4. Canbay O, Celebi N, Arun O, Karagoz AH, Saricaoglu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. British journal of anaesthesia. 2008;100(1):95-8.
5. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. European journal of anaesthesiology. 2010;27(3):253-7.
6. Vanlersberghe C, Camu F. Etomidate and other non-barbiturates. Handbook of experimental pharmacology. 2008(182):267-82.
7. Song JC, Lu ZJ, Jiao YF, Yang B, Gao H, Zhang J, et al. Etomidate Anesthesia during ERCP Caused More Stable Haemodynamic Responses Compared with Propofol: A Randomized Clinical Trial. International journal of medical sciences. 2015;12(7):559-65.
8. Song J-C, Lu Z-J, Jiao Y-F, Yang B, Gao H, Zhang J, et al. Etomidate anesthesia during ERCP caused more stable haemodynamic responses compared with propofol: a randomized clinical trial. International journal of medical sciences. 2015;12(7):559.
9. Aggarwal S, Goyal VK, Chaturvedi SK, Mathur V, Baj B, Kumar A. A comparative study between propofol and etomidate in patients under general anesthesia. Brazilian journal of anesthesiology (Elsevier). 2016;66(3):237-41.
10. Shen X-C, Ao X, Cao Y, Lan L, Liu X-M, Sun W-J, et al. Etomidate-remifentanil is more suitable for monitored anesthesia care during gastroscopy in older patients than propofol-remifentanil. Medical science monitor: international medical journal of experimental and clinical research. 2015;21:1.
11. Ye L, Xiao X, Zhu L. The Comparison of Etomidate and Propofol Anesthesia in Patients Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis. Surgical laparoscopy, endoscopy & percutaneous techniques. 2017;27(1):1-7.
12. Saliminia A, Azimaraghi O, Javadi A, Abdoulahpoor M, Movafegh A. [Comparison of granisetron and lidocaine on reducing injection pain of etomidate: a controlled randomized study]. Revista brasileira de anestesiologia. 2017;67(6):615-8.
13. Doenicke A, Roizen MF, Hoernecke R, Mayer M, Ostwald P, Foss J. Haemolysis after etomidate: comparison of propylene glycol and lipid formulations. British journal of anaesthesia. 1997;79(3):386-8.
14. Nyman Y, Von Hofsten K, Palm C, Eksborg S, Lonnqvist PA. Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. British journal of anaesthesia. 2006;97(4):536-9.
15. Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi J Anaesth. 2011;5(1):62-6.
16. Kwak K-H, Ha J, Kim Y, Jeon Y. Efficacy of combination intravenous lidocaine and dexamethasone on propofol injection pain: a randomized, double-blind, prospective study in adult Korean surgical patients. Clinical therapeutics. 2008;30(6):1113-9.
17. Azimaraghi O, Aghajani Y, Molaghadimi M, Khosravi M, Eslami K, Ghadimi F, et al. Ondansetron reducing pain on injection of etomidate: a controlled randomized study. Revista brasileira de anestesiologia. 2014;64(3):169-72.
18. Saricaoglu F, Uzun S, Arun O, Arun F, Aypar U. A clinical comparison of etomidate-lipuro, propofol and admixture at induction. Saudi journal of anaesthesia. 2011;5(1):62.
19. Gultop F, Akkaya T, Bedirli N, Gumus H. Lidocaine pretreatment reduces the frequency and severity of myoclonus induced by etomidate. Journal of anesthesia. 2010;24(2):300-2.
20. Choi JM, Choi IC, Jeong YB, Kim TH, Hahm KD. Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus. Journal of clinical anesthesia. 2008;20(8):601-4.
21. Nyman Y, Von Hofsten K, Ritzmo C, Eksborg S, Lönnqvist P. Effect of a small priming dose on myoclonic movements after intravenous anaesthesia induction with Etomidate-Lipuro in children. British journal of anaesthesia. 2011;107(2):225-8.
22. Kelsaka E, Karakaya D, Sarihasan B, Baris S. Remifentanil pretreatment reduces myoclonus after etomidate. Journal of clinical anesthesia. 2006;18(2):83-6.
23. Van Keulen SG, Burton JH. Myoclonus associated with etomidate for ED procedural sedation and analgesia. The American journal of emergency medicine. 2003;21(7):556-8.
24. Vanacker B, Wiebalck A, Van Aken H, Sermeus L, Bouillon R, Amery A. Quality of induction and adrenocortical function. A clinical comparison of Etomidate-Lipuro and Hypnomidate. Der Anaesthesist. 1993;42(2):81-9.
25. Zhang SS, Zhou C, Liu J, Kang Y, Zhang P, Zhang WS. [30% intralipid shortens the duration of anesthesia induced by etomidate in rats]. Sichuan da xue xue bao Yi xue ban = Journal of Sichuan University Medical science edition. 2013;44(3):402-4, 23.
26. Brock MF, Grace BE, Morley B, Hillegass G, Houle TT, Groban L. Does lidocaine more effectively prevent pain upon induction with propofol or etomidate when given preemptively than when mixed with the drug? Journal of clinical anesthesia. 2010;22(7):505-9.
27. Meera P, Olsen RW, Otis TS, Wallner M. Etomidate, propofol and the neurosteroid THDOC increase the GABA efficacy of recombinant α4β3δ and α4β3 GABA A receptors expressed in HEK cells. Neuropharmacology. 2009;56(1):155-60.
28. Kaushal RP, Vatal A, Pathak R. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass. Annals of cardiac anaesthesia. 2015;18(2):172.
29. St Pierre M, Dunkel M, Rutherford A, Hering W. Does etomidate increase postoperative nausea? A double-blind controlled comparison of etomidate in lipid emulsion with propofol for balanced anaesthesia. European journal of anaesthesiology. 2000;17(10):634-41.
30. Kaur S, Kataria AP, Kaur G, Kaur M, Attri JP, Mohan B. Comparison of Induction Characteristics of Propofol-Lipuro and Etomidate-Lipuro in Cardiac Patients in Non-cardiac Surgery. Int J Sci Stud. 2014;2(6):66-72.
| Files | ||
| Issue | Vol 6, No 4 (2020) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v6i4.5561 | |
| Keywords | ||
| Anesthesia; Etomidate; Pain; Randomized Clinical Trial | ||
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How to Cite
1.
Saliminia A, Esfahanian N. Comparison of Pain on Injection of Etomidate versus Etomidate-Lipuro in Patients Undergoing Elective Orthopedic Surgery: A Double-Blind Randomized Clinical Trial. J Orthop Spine Trauma. 2021;6(4):77-81.
