THE ANALGESIC EFFECT OF FENTANYL, MORPHINE, MEPERIDINE, AND LIDOCAINEIN THE PERIPHERAL VEINS - A COMPARATIVE-STUDY

Using venous retention with a tourniquet (70 nun Hg), we performed a r andomized, double-blind study to assess the efficacy of IV pretreatmen t with fentanyl, morphine, meperidine, or lidocaine in reducing propof ol injection pain. Immediately after venous occlusion with a tournique t,IV fentanyl 150 mu g (Group A, n = 35), morphine 4 mg (Group B, n = 35), meperidine 40 mg (Group C, n = 35), 2% lidocaine 3 mL (Group D, M = 35), or normal saline 3 mt (Group E, n = 35; as placebo control) wa s given to adult patients. The venous retention of the drug was mainta ined for 1 min, followed by tourniquet release and IV administration o f propofol 100 mg. Pain assessment was made immediately after the prop ofol injection, Lidocaine and meperidine significantly reduced propofo l injection pain more than placebo (P < 0.05), but there were more sid e effects in the meperidine group. Fentanyl and morphine reduced the i ntensity of propofol injection pain (P < 0.05) and had some effect in reducing the incidence of propofol injection pain, but the difference did not reach statistical significance. The order of efficacy was lido caine approximate to meperidine > morphine approximate to fentanyl. We postulate that the peripheral analgesic effect of these opioid is due to their local anesthetic activity. Implications: Propofol, a commonl y used anesthetic, often causes pain on injection. Given as venous ret ention pretreatments 1 min before propofol, meperidine and lidocaine w ere found to significantly reduce the propofol injection pain, whereas fentanyl and morphine only slightly reduced the propofol injection pa in.