Intravenous Dexmedetomidine Administration Prior Anesthesia Induction With Propofol at 4°C Attenuates Propofol Injection Pain: A Double-Blind, Randomized, Placebo-Controlled Trial.

Yayun Lu,Qing Xia,Zhiyue Xu,Xuefeng Tang,Lihua Liu,Yaping Gu

doi:10.3389/fmed.2021.590465

Abstract

Background: Propofol injection pain, despite various interventions, still occurs during the anesthesia induction and causes intense discomfort and anxiety in patients. This study aimed to explore the effect of intravenous dexmedetomidine on propofol injection pain prior to anesthesia induction with propofol at 4°C.Methods: A total of 251 patients (American Society of Anesthesiologists I–II) who underwent oral and maxillofacial surgery were randomly assigned to a combination group (n = 63), lidocaine group (n = 62), dexmedetomidine group (n = 63), and placebo-control group (n = 63); they received 0.5 ug/kg dexmedetomidine prior to anesthesia induction with propofol at 4°C, 40 mg lidocaine, 0.5 ug/kg dexmedetomidine prior to anesthesia induction, and normal saline, respectively. Incidence of pain, pain intensity, and reaction to the pain stimulus were evaluated by using verbal categorial scoring (VCS), a numerical rating scale (NRS), and the Surgical Pleth Index (SPI), respectively. In addition, hemodynamic parameters such as heart rate (HR) and mean arterial pressure (MAP) were also measured. The VCS and NRS were evaluated at 5 s after propofol injection. In addition, SPI, HR, and MAP were evaluated at three time points (before anesthesia induction and 5 and 30 s after propofol injection).Results: The incidence of pain in the combination group (51%) was significantly lower than that in the lidocaine group (71%), dexmedetomidine group (67%), or placebo-control group (94%) (p < 0.001). VCS and NRS scores in the combination group were also lower compared with the other three groups (p < 0.001), with no statistically significant differences between the lidocaine group and dexmedetomidine group (p > 0.05). The SPI of the combination group decreased significantly in comparison with the other three groups at 5 s after propofol injection (F = 96.23, p < 0.001) and 30 s after propofol injection (F = 4.46, p = 0.005). Further comparisons between HR and MAP revealed no significant differences across the groups (p > 0.05).Conclusion: Because of the sedative nature of dexmedetomidine and analgesic effect of low temperature, this study showed that intravenous dexmedetomidine prior to anesthesia induction with propofol at 4°C is highly effective in attenuating the incidence and severity of pain during injection compared with lidocaine (40 mg), dexmedetomidine 0.5 ug/kg) and placebo. This approach was not associated with any anesthesia complications.Clinical Trial Registration: ClinicalTrials.gov, identifier: ChiCTR-2000034663

Highlights

Propofol, a common intravenous anesthetic, is extensively used in induction, sedation, and maintenance of general anesthesia because of its rapid onset and quick patient recovery [1, 2]
Increasing evidence has demonstrated that the lipid solvent irritates the vein intima and activates a local kallikreinkinin cascade by releasing bradykinin and inflammatory factors [8, 9], and injection pain has been shown to occur when peripheral nerve endings are directly exposed to propofol [4]
No significant differences were found between the four groups regarding age, gender, status of American Society of Anesthesiologists (ASA), height, weight, heart rate (HR), mean arterial pressure (MAP), Surgical pleth index (SPI), recovery time, and dose of propofol for anesthesia induction (p > 0.05)

Summary

Introduction

A common intravenous anesthetic, is extensively used in induction, sedation, and maintenance of general anesthesia because of its rapid onset and quick patient recovery [1, 2]. About 28–90% of patients receiving propofol injection via the dorsal hand vein suffer different levels of pain intensity [3, 4]. Injection pain may influence the quality of anesthesia in patients and cause an unpleasant experience [4, 6, 7]. Several factors account for propofol injection pain. Investigations of clinical factors have revealed that female patients of younger age, with a peripheral vein site (especially the dorsum of hand), are highly sensitive to injection pain [10]. Despite various interventions, still occurs during the anesthesia induction and causes intense discomfort and anxiety in patients. This study aimed to explore the effect of intravenous dexmedetomidine on propofol injection pain prior to anesthesia induction with propofol at 4◦C

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Discussion

Conclusion