Pain
Conditions
Keywords
hypnoanalgesia, lidocaine, propofol, children
Brief summary
The simplicity of the implementation and the effectiveness of hypno-analgesia (via the magic glove technique) has already been proven in some research work, during the installation of peripheral venous route. An unpublished preliminary study has shown that this method appears to be the most effective in preventing pain during pediatric propofol injection. The purpose is to compare the effectiveness of hypno-analgesia of the hand by the magic glove technique to lidocaine used in an extemporaneous mixture in the prevention of pain with injection of propofol during intravenous induction in children aged 7 to 14 years
Detailed description
Propofol is a hypnotic of choice, because of its speed of action, its dose-effect relationship (allowing titrated inductions), its anti-emetic effect, as well as its delay and its short duration of action. Among its side effects, the pain during its injection occupies a significant part in pediatrics (60% in adults, up to 85% in children). It is most often described as an unpleasant sensation, discomfort or even a burn at the point of puncture, going up along the path of the vein and can extend to the whole arm. The mechanism of this pain is still poorly understood at this time. Several mechanisms have been mentioned such as activation of the bradykinin cascade, a direct stimulation of the free nociceptive venous nerve endings.A meta-analysis concludes in adults that the two most effective techniques are a puncture site on the ulnar vein and a pretreatment of the vein by Lidocaine. In children, the anatomical differences, the notion of protection of the venous capital from the first vascular approach, whatever the prognosis of the patient and the competence of the operator will influence the choice of the material, the choice of the site and the puncture technique. Several pediatric studies have attempted to reduce this injection pain by other techniques. A panel of products has been tested with different drug orientations or not. The suggestion centered on analgesia of the hand is a powerful technique, adapted to acute pain. The pain sensation will thus be partially or completely replaced by a sensation of a different nature, thus attenuating the nociceptive process. This technique has not been studied during injection with propofol.
Interventions
PROCEDUREMagic glove hypnosis technique
Realization of the magic glove hypnosis technique by an expert physician trained in hypnosis, according to a classic discourse before : intravenous infusion with 1% propofol (3 mg/kg with 600 ml / h electric syringe pump). Use and dose in accordance with the SPC.
DRUGlidocaine
intravenous infusion with an extemporaneous mixture of 18 volumes 1% propofol (180mg) for 2 volumes of 1% lidocaine (2ml) with 600 ml / h electric syringe pump. Use and dose in accordance with the SPC.
Sponsors
University Hospital, Toulouse
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
7 Years to 14 Years
Healthy volunteers
No
Inclusion criteria
* Children from 7 to 14 years old. * Admitted for programmed or ambulatory surgery under general anesthesia. * ASA I to II. (ASA1: Normal patient or ASA 2: Patient with moderate systemic abnormality). * Parents or legal guardians who have signed informed consent to the inclusion visit.
Exclusion criteria
* Children under 7, over 14 * In regulated girls, presence of a pregnancy * ASA III, IV * Contraindication to propofol (known hypersensitivity to propofol or to one of its constituents) * Contraindications to lidocaine (known hypersensitivity to lidocaine hydrochloride, amide bonded local anesthetics or to any of the excipients, patients with recurrent porphyria) * Contraindications to nitrous oxide * Patient whose clinical condition requires titration of propofol during induction, for good hemodynamic tolerance. * Refusal by the child or the parents of intravenous induction. * Psychological distress (agitation, mental deficiencies, communication disorders, deafness problems). * Analgesic or sedative treatment within 24 hours before induction. * Locoregional or perimedullary anesthesia before anesthetic induction.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity Score: Cameron Type Scale | Day 1 | The reactions of the child from the beginning of the injection are filmed by an outside observer. At the end of the 3 mg / kg, the observation is stopped. From a distance, a member of the Children's Hospital Pain Unit will blindly display, by viewing child-centered videos, a pain score, according to Cameron's score \[0 = No pain ( no reaction); 1 = slight pain (grimace); 2 = Moderate pain (grimaces + cries / moans); 3 = severe pain (crying / crying + hand removal).\]. A score greater than or equal to two represents a significant pain at induction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Satisfaction assessment | Day 1 | Evaluation of the satisfaction as soon as the child is able to leave the post interventional surveillance room (sspi) by an analog evaluation scale of the degree of satisfaction. A score ≤ 7 expressing dissatisfaction on his part, the reasons for this possible discontent will then be requested. Then, we will ask him, in case he should be asleep, if he wants us to proceed in the same way. |
Countries
France
Outcome results
None listed