Influence Of Local Infiltration Of Lidocaine On The Effect Of Target Controlled Infusion Of Propofol In Conization Of Cervix

Objective To investigate the influence of local infiltration of lidocaine in conization of cervix by comparing local infiltration of lidocaine combined target controlled infusion of propofol and target controlled infusion of propofol only.Methods Fifty ASAⅠorⅡpatients(age 25～55, weight 45～70kg, BMI 21～25kg/m2), scheduled for elective conization of cervix, were randomly double-blindly divided into two groups (n=25):lidocaine local anesthesia group(group LP) were infiltrated around cervix with 20ml of 1% lidocaine including 1:400000 adnephrin; control group (group P) were infiltrated around cervix with 20ml of normal saline including 1:400000 adnephrin only. All the patients were premedicated with intramuscular Phenobarbital sodium 0.1g and scopolamine 0.3mg 30 min before anesthesia. ECG, NBP, RR, SpO2 and BIS were continuously monitered. Both two groups were twice i.v. fentanyl of 1μg/kg 6 min before the operation. The TCI of propofol was started 3 min before the operation, and the initial target concentration of propofol was set at 3.0mg/L, setting the target concentration of propofol (0.3μg/ml per time) to maintain OAA/S sedation score at 2. The TCI was stopped at 5 min before the end of the operation. During the operation, all patients had spontaneously breathing and oxygen inspired with face mask(oxygen flow 3L/min). If respiratory depression happened (SpO2<95), supporting submaxilla, parichnos and face mask pressurize venting were given to assist respiration, keeping SpO2 exceeding 95. HR SBP, DBP, MAP, RR, SpO2, BIS and target effective-site concentration of propofol TCI were recorded immediately before anesthetic induction (T0), immediately before the operation (T1), at 10 and 20 min after the beginning of operation (T2, T3), at the end of operation(T4), when the patients regained consciousness (T5), and when the patients left (T6). The total amount of propofol, the incidence of respiratory depression and the duration of operation, regaining consciousness and leaving room were recorded as well. Results There was no significant difference in age, body height and weight, basic level of vital sign and duration of operation between the two groups (P>0.05). The BIS index were higher in group LP than in group P (P<0.05). The incidence of respiratory depression was highly significantly lower in group LP than in group C (P<0.01). Before the operation (T1), SBP, DBP, MAP of the two groups reached the lowest level (P<0.01). During operation (T2-T4), HR in group P was significantly faster than the basic level and that in group LP (P<0.05 or P<0.01). The rangeability of SBP, MAP was more large in group P than in group LP at T2, T4 (P<0.05). After operation(T5,T6), SBP, DBP, MAP in group P were significantly higher than the basic level and those in group LP (P<0.05 or P<0.01), and there was significant difference between the two groups (P<0.05). The duration of eye-opening and leaving room were highly significantly shorter in group LP than in group P (P<0.01). The target effective-site concentration of propofol during and after operation (T2-T5) and the amount of propofol were highly significantly lower in group LP than in group P (P<0.01).Conclusion Local infiltration of lidocaine around the cervix in conization of cervix can reduce the target effective-site concentration of propofol administered by TCI, then reduce the amount of propofol. It is also more helpful in maintaining hemodynamics stability, reducing the incidence of respiratory depression and shortening the time of regaining consciousness and recovery.