Efficacy of Ephedrine Versus Lignocaine Pretreatment In Preventing Pain Following Propofol Injection: A Prospective, Randomized, Double-blind, Placebo-controlled Study.

Abstract

Background: Injection pain and hypotension are the two main adverse effects of propofol. The commonly used lignocaine pretreatment for reducing injection pain has a failure rate between 1332 %. There are few studies in literature using ephedrine pretreatment for reduction of propofol injection pain and these studies have also looked at the effect of ephedrine in overcoming hypotension and hemodynamic stability, each with varying results. We studied the effect of ephedrine 50μg/kg pretreatment on prevention of propofol injection pain and hemodynamics.Methods: This prospective, randomized, double-blind, placebocontrolled study was conducted after obtaining institutional ethical committee approval. Patients (eighty one patients) were randomly allocated to one of three groups. Each group consisting 27 (n= 27) patients were to receive one of lignocaine (Group L, n = 27), normal saline (Group S, n = 27) or ephedrine (Group E, n = 27) as pretreatment. Group Lpretreatment with 2% lignocaine 2 ml. Group Spretreatment with 0.9% normal saline 2ml, Group Epretreatment with ephedrine 50 μg/kg body weight diluted in normal saline into a 2 ml normal saline solution. Propofol was injected 30 sec later. A blinded researcher assessed the patient's pain level using a four point verbal rating scale.Results: There was no significant difference with respect to patient's characteristics and hemodynamic changes during propofol induction among the three groups. There was a statistically significant difference in the incidence of pain between groups. Patients who received lignocaine pretreatment group had 51.8% pain. The Normal saline pretreatment group had 77.8% pain. Ephedrine pretreatment group had pain as high as 70.4 %.Conclusion: Ephedrine used as pretreatment in dose of 50 μg/kg is neither useful to decrease propofol injection pain nor to maintain better hemodynamic.