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Abstract

Introduction: The administration of the bolus injection of propofol is frequently associated with significant and often distressing pain. This pain is magnified in children. The objective of this prospective randomized study was to assess differences in pain experience with propofol injection in two different intravenous (IV) sites (antecubital fossa vs. dorsum of hand), in children with the goal of identifying the preferred site for propofol administration. Methods: A total of 136 children, 1-18 years old assessed as American Society of Anesthesiologist (ASA) class I–II undergoing sedation with propofol for magnetic resonance imaging (MRI) during January 2013 to July 2013, were placed into two groups by IV site. Initial IV site attempted was randomized by day of the week. Pain was assessed by independent of the study nurses using the 10 point Face, Activity, Cry and Consolability (FLACC) scale during injection. FLACC scores were assessed three times, in pre-sedation before entering the MRI suit, in the MRI machine room presedation and upon administration of the bolus dose of propofol. Chi square and t-tests were used to assess differences in patient characteristics comparing the two IV site groups. Group differences in FLACC scores in all 3 instances were evaluated with Wilcoxon Signed Ranks and Wilcoxon Rank Sums tests. Results: The sample included 72 females and 64 males. Mean age was 77.2 +/- 39.5 months and weight 26.9 +/- 16.3 kg. Groups were not significantly different in gender allocation, mean age or weight. Admission and MRI room FLACC scores were not statistically significant by IV site. However, in response to propofol administration, FLACC scores for the hand IV site (median = 5, mean =4.93) were significantly higher than for the antecubital site (median =3, mean=3.34) (p-0.004). Conclusions: Our findings demonstrated the pain experience during propofol administration in antecubital fossa veins is significantly less than dorsum of the hand. We suggest that all effort should be made to use this IV access site.