Injection Of Microemulsion Propofol Research Articles

Effects of Intravenous Magnesium Sulfate on the Prevention of Pain Following Injection of Microemulsion Propofol

Objective: The aim of this study was to investigate the effects of intravenous magnesium sulfate on the prevention of pain during the injection of microemulsion propofol. Magnesium is a known calcium channel blocker and a physiological N-methyl-D-aspartate receptor antagonist. Methods: American Society of Anesthesiologists I and II adults (n= 114) undergoing general anesthesia for surgery were randomly assigned into two groups (n= 57 per group). This study was designed in prospective and double-blind manner. Patients in the LM group (n= 57) received pretreatment with 2% lidocaine (40 mg) and magnesium sulfate 10 mg/kg, while patients in group L (n= 57) received pretreatment with 2% lidocaine (40 mg) and normal saline (2 mL) accompanied by venous occlusion. Induction with microemulsion propofol (Aquafol) 2 mg/kg was accomplished following the release of venous occlusion. Pain intensity was assessed on a four-point scale according to patient movement (grade 0, no movement; grade 1, movement in wrist only; grade 2, movement in the upper arm & shoulder of injected arm; grade 3, generalized movement). Systolic blood pressure, diastolic blood pressure, and heart rate were evaluated. Results: A significant difference in pain intensity following injection of microemulsion propofol between the groups was found (P< 0.05). In addition, the incidence of hypertension after injection was lower in the LM group than in the L group (P< 0.05). Conclusion: The combination of magnesium and lidocaine are effective in attenuating the pain induced by microemulsion propofol injection when compared with lidocaine alone.

Intravenous lidocaine pretreatment with venous occlusion for reducing microemulsion propofol induced pain: Comparison of three doses of lidocaine

Pretreatment with intravenous 40 mg or 0.5 mg/kg lidocaine with venous occlusion is recommended to prevent pain following injection of lipid emulsion propofol. This approach is not sufficient to prevent pain from the injection of microemulsion propofol. The present study investigated whether a higher dose of lidocaine pretreatment with venous occlusion would be more effective for reducing pain following injection of microemulsion propofol compared with 40 mg lidocaine. Patients undergoing elective surgery were randomly assigned to one of three groups: pretreatment with 40 mg (group L40), 60 mg (group L60) or 80 mg (group L80) lidocaine intravenously with venous occlusion, followed by injection with microemulsion propofol 1 min later. Pain was assessed on a four-point scale (severe, moderate, mild, none) based on physical responses to the injection. A total of 68 patients were included in the final analysis. Pain severity and incidence were significantly lower in patients in group L60 and L80 compared with patients in group L40. There were no statistically significant differences in pain incidence or severity between group L60 and group L80. Pretreatment with 60 mg lidocaine intravenously with venous occlusion may be the most effective minimum dose for reducing injection pain following microemulsion propofol administration for induction of anaesthesia.

Reducing the Pain of Microemulsion Propofol Injections: A Double-Blind, Randomized Study of Three Methods of Tourniquet and Lidocaine

BackgroundAlthough the new formulation of lipid-free microemulsion propofol (MP) has some advantages over the lipid emulsion, it reportedly produces more injection pain than lipid-based propofol. Intravenous lidocaine with application of a rubber tourniquet before administration of propofol is considered to be the best method for reducing injection pain; however, this technique is not perfect. ObjectiveThe goal of this study was to evaluate the effect of different methods of tourniquet application and lidocaine administration on MP injection pain. MethodsThis single-center, randomized controlled clinical trial was conducted in 140 patients aged 18 to 65 years. Patients were randomly divided into 4 groups (n = 35 each). Group A received MP (2 mg/kg) after lidocaine (0.6 mg/kg) with a tourniquet with arm down (venous engorgement); group B received MP after lidocaine with a tourniquet with arm up (venous gravity drainage); group C received MP with a tourniquet with arm down; and group D (control group) received MP only (with no tourniquet). In groups A and C, the tourniquet was released after MP; in group B, the tourniquet was released before MP. Injection pain was evaluated by using a verbal pain score (VPS). The bispectral index, the time from the beginning of drug injection to the loss of eyelash reflex, and time to the lowest bispectral index value were recorded. ResultsGroup A showed significantly less incidence of pain than the control group when MP was injected. The mean VPS was significantly lower in groups A, B, and C than in group D (the control group). The VPS of group A was significantly lower than that in group B. Other observed values were not significantly different. ConclusionsWe concluded that intravenous retention of lidocaine with the application of a rubber tourniquet under venous engorgement of the arm reduces the incidence and intensity of MP injection pain. Clinical trial registry: UMIN000010725.

The effect of gender on EC50of remifentanil to prevent pain during injection of microemulsion propofol

BackgroundPropofol injection pain is an unpleasant experience to patients and its prevalence can be influenced by age and gender. We determined the half maximal effective concentration (EC50) of remifentanil for preventing the microemulsion propofol injection pain in the male and female adult groups.MethodsAfter institutional review board approval, a total of 60 patients were assigned into 2 groups depending on their gender: group M (male, 20-65 yr) and group F (female, 20-65 yr). Anesthesia was induced with propofol and remifentanil, by a target-controlled infusion. Target effect-site concentration (Ce) of propofol and remifentanil for the first patient started at 4.0 ug/ml and 4.0 ng/ml. Ce of remifentanil for each subsequent patient was determined by the response of the previous patient by the Dixon's up-and-down method (DUDM) with an interval of 0.2 ng/ml. After equilibration of plasma and effect site remifentanil concentration, propofol was administered, and the pain responses were observed.ResultsThe remifentanil EC50 was 3.8 ± 0.2 and 2.7 ± 0.2 ng/ml in groups M and F, respectively, by DUDM. From Probit regression model, the remifentanil EC50 was 3.7 (3.0-4.3) and 2.7 (1.8-2.9) ng/ml in groups M and F, respectively.ConclusionsThe remifentanil EC50 for preventing the moderate to severe injection pain of propofol was higher in males than in females.

Reduction of Microemulsion Propofol-Induced Injection Pain via Target-Controlled Remifentanil Infusion

The intravenous injection of microemulsion propofol to induce anaesthesia causes more intense and frequent pain than lipid emulsion propofol. This study investigated whether different target effect-site concentrations of remifentanil could prevent pain due to microemulsion propofol injection. In total, 96 patients were randomly assigned to one of three groups receiving target effect-site concentrations of remifentanil 0 (control group), 4 or 6 ng/ml, followed by injection with microemulsion propofol. Remifentanil pretreatment significantly reduced the incidence and severity of injection pain compared with the control group. Although no difference in pain reduction between the two remifentanil-treated groups was observed, those receiving a target effect-site concentration of 6 ng/ml exhibited an increased rate of complications, compared with those receiving 4 ng/ml. In conclusion, prior administration of remifentanil at a target effect-site concentration of 4 ng/ml is a useful strategy to decrease the injection pain of microemulsion propofol.

Prevention of microemulsion propofol injection pain: a comparison of a combination of lidocaine and ramosetron with lidocaine or ramosetron alone

BackgroundA microemulsion propofol causes a high incidence of pain during intravenous injection. In this study, we investigated the effect of ramosetron on pain induced by microemulsion propofol injection.MethodsAfter prospective power analysis and institutional review board approval, a total of 200 ASA I and II patients undergoing general anesthesia were divided into 4 groups. They received one of the following intravenously after tourniquet application on the forearm 1 min before induction of anesthesia using microemulsion propofol; normal saline (Group N, n = 50), lidocaine 20 mg (Group L, n = 50), ramosetron 0.3 mg (Group R, n = 50) and lidocaine 20 mg plus ramosetron 0.3 mg (Group LR, n = 50) diluted into a 5 ml solution. The occlusion was released after 30 seconds and microemulsion propofol was injected over 10-15 seconds. The patients were observed and asked immediately if they had pain in the arm, and their responses were assessed.ResultsThe incidence of pain in groups N, L, R and LR was 96%, 76%, 60% and 38%, respectively (P < 0.008). Two patients in Group LR (4.0%) and nine in Group R (18.0%) had moderate to severe pain, which was significantly lower than pain in Groups N (84.0%), L (40.0%) and R (P < 0.008).ConclusionsPretreatment with ramosetron 0.3 mg with or without lidocaine 20 mg with a tourniquet on the forearm 30 seconds before the injection of microemulsion propofol is more effective than lidocaine 20 mg or normal saline in preventing pain from a microemulsion propofol injection.

The effect and optimal dose of sufentanil in reducing injection pain of microemulsion propofol

BackgroundPropofol is used as an induction and maintenance agent for general anesthesia but it can cause adverse reactions like hyperlipidemia, growth of microorganisms, and pulmonary embolisms. Microemulsion propofol was developed to avoid these side effects but incidence and severity of pain on injection is higher than with lipid emulsion propofol. We aimed to compare the effects of sufentanil in analgesic doses for reducing the injection pain of microemulsion propofol.MethodsThe candidates included eighty patients, 19-60 years old and ASA I-II. They were randomly classified into four groups and pretreated with normal saline, sufentanil 0.1 µg/kg, 0.2 µg/kg or 0.3 µg/kg before injection of microemulsion propofol. Five minutes after receiving pretreatment drug, 2 mg/kg of microemulsion propofol was injected and VAS was recorded.ResultsThere were no significant differences in the incidence of injection pain among the groups. Severity of injection pain was significantly lower in the sufentanil 0.3 µg/kg group than normal saline and sufentanil 0.1 µg/kg group. Significant differences in blood pressure and heart rate were observed in sufentanil groups only after endotracheal intubation. One patient each in sufentanil 0.1 µg/kg and 0.3 µg/kg group experienced mild cough, one from sufentanil 0.3 µg/kg group experienced dizziness and another showed signs of hypoxia. One patient each in normal saline and sufentanil 0.1 µg/kg group showed clinical symptoms of phlebitis in the injection area.ConclusionsPretreatment with sufentanil 0.3 µg/kg reduced the severity of microemulsion propofol injection pain without increasing arterial blood pressure and heart rate after endotracheal intubation.

The effect of priming injection of different doses of remifentanil on injection pain of microemulsion propofol premixed with lidocaine

BackgroundThe injection pain of microemulsion propofol is frequent and difficult to prevent. This study examined the prevention of pain during microemulsion propofol injection by pretreatment with different doses of remifentanil or saline, and premixing of lidocaine.MethodsOne hundred sixty ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into one of four groups (n = 40, in each). The patients received saline (group LS), remifentanil 0.3 µg/kg (group LR 0.3), remifentanil 0.5 µg/kg (group LR 0.5), or remifentanil 1.0 µg/kg (group LR 1.0), and after 90 seconds received an injection of 2 mg/kg microemulsion propofol premixed with lidocaine 40 mg. Pain was assessed on a four-point scale during microemulsion propofol injection.ResultsThe incidence of microemulsion propofol-induced pain was significantly lower in the LR 0.3, LR 0.5 and LR 1.0 groups than in the LS group (37.5%, 12.5% and 10% vs 65%, respectively). The LR 0.5 and LR 1.0 groups showed significantly less frequent and intense pain than the LR 0.3 group. However, both incidence and severity of pain were not different between LR 0.5 and LR 1.0 groups.ConclusionsThe combination of remifentanil and lidocaine is effective in alleviating pain associated with a microemulsion propofol injection compared with just lidocaine. Remifentanil 0.5 µg/kg had a similar analgesic effect compared to the 1.0 µg/kg dose.

Ondansetrone and lidocaine: Comparative analysis for pain on injection of microemulsion propofol

Ondansetrone and lidocaine: Comparative analysis for pain on injection of microemulsion propofol

Prevention of pain with the injection of microemulsion propofol: a comparison of a combination of lidocaine and ketamine with lidocaine or ketamine alone

BackgroundAquafol, a microemulsion propofol, causes more severe and frequent pain on injection than propofol. The purpose of this study was to compare a combination of lidocaine and ketamine on aquafol-induced pain with lidocaine or ketamine alone during the induction of anesthesia.MethodsIn this prospective, randomized, double-blinded study, 130 healthy patients who were undergoing elective surgery under general anesthesia were enrolled. The patients received IV lidocaine 40 mg plus ketamine 25 mg (Group LK, n = 43), lidocaine 40 mg (Group L, n = 42), or ketamine 25 mg (Group K, n = 45) with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol. The pain score was assessed by a 4-point verbal rating scale (VRS) at 10 seconds after injection of microemulsion propofol 30 mg and during the injection of the remaining total dose.ResultsThe incidence and severity of pain was significantly lower in Group LK than Group L or Group K at 10 seconds after the injection of microemulsion propofol 30 mg (P < 0.05). And the incidence and severity of pain was significantly lower in Group LK and Group K than Group L during the injection of the remaining total dose (P < 0.05).ConclusionsPretreatment with IV lidocaine 40 mg plus ketamine 25 mg with a rubber tourniquet on the forearm 1 min before the injection of microemulsion propofol is more effective than lidocaine 40 mg or ketamine 25 mg alone in preventing pain from the injection of microemulsion propofol.

Pain reduction on injection of microemulsion propofol via combination of remifentanil and lidocaine

BackgroundMicroemulsion propofol produces more frequent and severe pain upon injection than lipid emulsion propofol. This study examined the analgesic effect of lidocaine-premixed microemulsion propofol in patients pretreated with remifentanil. The induction of anesthesia with this combination was compared with microemulsion propofol accompanied with either remifentanil or lidocaine.MethodsOne hundred twenty patients aged between 20-65 years old were allocated randomly into one of three groups (n = 40, in each). The patients in the remifentanil group received remifentanil 0.5 µg/kg IV for 30 seconds before a microemulsion propofol injection. The patients in the lidocaine group received propofol 2 mg/kg premixed with 40 mg lidocaine over a 60 second period. The patients in the combination group received both remifentanil and lidocaine.ResultsThere was a significantly lower incidence of microemulsion propofol injection pain (severity 2 or more) in the combination group (12.5%) than in the remifentanil and lidocaine groups (90% and 65%, respectively, P < 0.05). The incidence of moderate pain disappeared completely in the combination group (0%) compared to that in the remifentanil and lidocaine group (32.5% and 20%, respectively, P < 0.05). Severe pain did not appear in any of the three groups. There were no complications on the injection site in the lidocaine alone and combination groups.ConclusionsThe combination of microemulsion propofol premixed with lidocaine after a pretreatment with remifentanil was more effective in reducing the incidence of pain upon the injection of microemulsion propofol than either treatment alone.

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

BackgroundSimilar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture.MethodsOne hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe.ResultsThe incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05).ConclusionsThe lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.

Pain on injection with propofol

The use of propofol often results in pain on injection, which is sometimes very distressing to patients. In analysis of 6,264 patients in 56 reports, 70% of all control patients reported some degree of pain or discomfort on injection with propofol [1]. In 1998, Tan and Onsiong [2] suggested that a wise choice would be to use a combination of techniques, such as alfentanil pretreatment, mixing lidocaine with the propofol and injecting into a large vein with no carrier fluid to decrease the incidence and severity of propofol injection pain. McCrirrick and Hunter [3] found that administering propofol at 4℃, significantly reduces the incidence of injection pain. Prior injection of cold saline reduces the incidence of pain and discomfort significantly compared with unmodified propofol and is similar to that after cold propofol and propofol with lidocaine [4]. However, the incidence of pain with cold propofol and lidocaine is not statistically different from room temperature propofol and lidocaine in children [5]. Cho et al. [6] assessed the effectiveness of cold propofol and pretreatment with remifentanil in minimizing pain associated with the injection of propofol and investigated whether a combination of cold propofol and remifentanil produced additional analgesic efficacy. They found that a combination treatment with 0.5 µg/kg remifentanil pretreatment and cold propofol significantly reduces the incidence and severity of propofol injection pain compared with each treatment used alone. The aqueous phase, which contains free propofol, is known to be associated with the intensity of pain at the injection site. Yamakage et al. [7] recommended the use of propofol medium-chain triglyceride (MCT)/long-chain triglyceride (LCT) for reducing pain on injection, because the concentrations of free propofol are significantly smaller by 30-45% than those in propofol LCT. Mallick et al. [8] reported that premixing 40 mg of lidocaine to Lipuro® propofol (a propofol formulated as an emulsion of 50% MCT and 50% LCT) almost abolishes the pain on injection, making induction of anesthesia less painful compared to Lipuro® propofol alone or Diprivan® propofol (a propofol formulated as an emulsion in a solution of 10% soybean oil containing only LCT) with lidocaine. A lipid-free microemulsion propofol (Aquafol®) was developed to avoid the risk of lipid solvent-related adverse drug reactions, and the efficacy and safety are not different from those of Diprivan® [9]. Microemulsion propofol produces more frequent and severe pain on injection than lipid emulsion propofol, a difference that may be attributable to the seven-fold higher concentration of aqueous free propofol [10]. Kim et al. [11] investigated the effect of a lidocaine mixture on microemulsion propofol injection pain and sought to determine the optimal dose of lidocaine that reduced pain on injection of propofolidocaine mixture. They used 20, 30, and 40 mg lidocaine, and the incidence of pain was 80%, 65%, and 50%, respectively, compared with 97.5% in a control group. Within this lidocaine dose range, increasing the lidocaine dose significantly lessened the pain during injection of microemulsion propofol. However, it is difficult to conclude that 40 mg of lidocaine is an optimal dose because a 50% incidence of injection pain is too high. Although several single or combination methods with lipid emulsion propofol nearly abolish pain on injection, further studies to search for an effective and safe method to reduce pain on injection, especially with microemulsion propofol, are needed until a better and safer propofol is available for clinical use in the near future.