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. 2016 Feb 18;2016(2):CD007874. doi: 10.1002/14651858.CD007874.pub2

Akgun 2013.

Methods Double‐blind randomized controlled trial
Participants Age (years, mean ± SD): Group E = 39.1 ± 13.7, Group L = 41.8 ± 11.8, Group S = 40.2 ± 2.8
Gender (M:F): Group E = 11:19, Group L = 12:18, Group S = 12:18
Inclusion criteria: aged 18 years to 60 years, ASA I or II, elective surgical procedures, lasting 1 to 3 hours,
Exclusion criteria: obesity (body mass index > 30 kg/m2), pregnancy, risk of aspiration of gastric contents, suspected or known difficult airway, presence of severe neurologic deficits or psychiatric disorders, use of medications likely to affect central nervous system, use of NSAIDs and opioids, significant cardiac and liver dysfunction, hypersensitivity to study drugs.
Recruitment: 90 adult patients randomly assigned (30 in each group)
Setting: Turkey
Interventions Pretreatment with venous occlusion
A 20 G cannula was inserted into the dorsum of the nondependent hand. After venous occlusion for one minute,
Groups E, L and S were pretreated with 5 mg/ml (total 2 ml) esmolol, 40 mg lidocaine and 2 ml saline IV respectively.
 After release of venous occlusion, one fourth of the total propofol dose was administered at a rate of 0.5 ml/sec
Outcomes Pain intensity assessed on 4‐point scale
0 = no pain
1 = mild pain
2 = moderate pain
3 = severe pain
Outcomes reported and used

  1. Incidence of high‐intensity pain

  2. Incidence of pain

  3. Adverse effects


Outcomes sought but not reported

  1. Patient satisfaction


Outcomes reported but not used

  1. Heart rate and noninvasive arterial blood pressure values
Notes Period of the study: dates not reported
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computer‐generated table of random numbers
Allocation concealment (selection bias) Unclear risk N/A
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk "All pretreatment drugs were prepared in 2 ml and coded by an anaesthesiologist who was not involved directly in the study."
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk A blinded anaesthesiologist
Incomplete outcome data (attrition bias) 
 All outcomes Low risk No withdrawals
Selective reporting (reporting bias) Unclear risk N/A
Other bias Low risk The study appears to be free of other sources of bias