Prevention Of Propofol Injection Pain Research Articles

5-HT3 Receptor Antagonists for Propofol Injection Pain: A Meta-Analysis of Randomized Controlled Trials.

5-hydroxytryptamine3 (5-HT3) receptor antagonists have been commonly used to reduce propofol injection pain. The aim of this meta-analysis was to evaluate the efficacy and safety of 5-HT3 receptor antagonists in decreasing the incidence and intensity of propofol injection pain. Online databases of Pubmed, Embase and the Cochrane Central Register of Controlled Trials were searched as well as reference lists of included studies and recent reviews. Eligible randomized controlled trials (RCTs) assessing the efficacy and safety of 5-HT3 receptor antagonists for propofol injection pain were identified. The outcomes included the incidence and intensity of propofol injection pain and adverse effects. We calculated risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous data and adopted fixed or random-effects model when proper. A total of eight RCTs were included in the final analysis. Compared with the control group, 5-HT3 receptor antagonists were related to a decreasing incidence of propofol injection pain (RR 0.43, 95% CI 0.33-0.56, P<0.05). Besides, they also effectively alleviated the severity of propofol injection pain. They significantly reduced the number of patients with moderate (RR 0.21, 95% CI 0.15-0.30, P<0.05) and severe pain (RR 0.16, 95% CI 0.10-0.25, P<0.05) during propofol injection. 5-HT3 receptor antagonists and lidocaine were equally effective in preventing propofol injection pain. Moreover, only one article mentioned the adverse effects of 5-HT3 receptor antagonists in two patients. Our meta-analysis indicates that 5-HT3 receptor antagonists can effectively reduce the incidence and severity of propofol injection pain. Additionally, 5-HT3 receptor antagonists may become the alternatives to lidocaine in attenuating propofol injection pain. However, evidence is still limited for the safety of 5-HT3 receptor antagonists on propofol injection pain.

Effects of a fentanyl-propofol mixture on propofol injection pain: a randomized clinical trial.

BackgroundPropofol injection pain is a common problem that can be very distressing for patients. We compared the effects of injection with saline followed by injection with a fentanyl-propofol mixture, injection with fentanyl followed by a propofol injection, and injection with saline followed by propofol alone on propofol injection pain.MethodsThe patients were assigned randomly to one of three groups. A rubber tourniquet was placed on the forearm to produce venous occlusion for 1 min. Before anesthesia induction, group C (control, n = 50) and group M (fentanylpropofol mixture, n = 50) received 5 ml of isotonic saline, while group F (fentanyl, n = 50) received 2 µg/kg of fentanyl. After the tourniquet was released, groups C and F received 5 ml of propofol and group M received 5 ml of a mixture containing 20 ml of propofol and 4 ml of fentanyl. At 10 s after the study drugs were given, a standard question about the comfort of the injection was asked of the patient. We used a verbal rating scale to evaluate propofol injection pain. Statistical analyses were performed with Student's t-tests and Fisher's exact tests; P < 0.05 was considered to indicate statistical significance.ResultsThe demographic data were similar among the groups. In group M, the number of patients reporting propofol injection pain was significantly lower than in groups F and C (both P < 0.001). No patient in group F or M experienced severe pain, whereas 24 patients (48%) had severe pain in group C (both P < 0.001).ConclusionsThis study shows that a fentanyl-propofol mixture was more effective than fentanyl pretreatment or a placebo in preventing propofol injection pain.

Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial.

Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain. After institutional review board (IRB) approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (50mg), magnesium sulfate (0.25mg), lidocaine (50mg) plus magnesium sulfate (0.25mg), or 0.9% sodium chloride. Following pretreatment, propofol (50mg) was administered, and subjects were questioned regarding injection site pain and observed for behavioral signs of pain. Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (57%), followed by those pretreated with placebo (46%), lidocaine plus magnesium sulfate (41%), and then lidocaine (29%; p=0.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p=0.031 and p=0.0003, respectively). In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.

Preemptive dexmedetomidine to prevent propofol injection pain in children.

The incidence of propofol injection pain is high in children, but no methods have been found to suppress it completely. This study intends to evaluate the efficacy of dexmedetomidine-midazolam in preventing propofol injection pain in children. One-hundred ASA I patients, aged 3-12 years, weighing 15-53 kg, undergoing elective surgery were randomized into two groups of 50 each, using computer-generated random numbers. Normal saline 0.15 ml/kg in Group C or dexmedetomidine 0.6 μg/kg in Group D was infused IV over 10 min. Then midazolam 0.06 mg/kg was administered immediately; 2 min after aforementioned treatments in each group, all patients received propofol 2 mg/kg (propofol was mixed with lidocaine 1 mg/ml in Group C) at an average rate of 0.2 ml per 1 s. Another anesthesiologist, blind to the pretreatment, recorded the occurrence of injection pain using a four-graded pain scale: 1 = no pain (no reaction to injection), 2 = slight pain (minor verbal/facial response or motor reaction to injection), 3 = moderate pain (clear verbal/facial response or motor reaction to injection) and 4 = severe pain (the patient both complained of pain and withdrew the arm). Forty (80 %) patients in Group C (control) had injection pain; however, none of patients in Group D had any injection pain. The total incidence of profol-induced pain in Group C was significantly higher (P < 0.01). There were no instances of bradycardia or low blood pressure with either treatment in this study. Pretreatment with dexmedetomidine 0.6 μg/kg, then midazolam 0.06 mg/kg could suppress propofol injection pain in children.

Effect of lidocaine volume and concentration on preventing incidence and severity of propofol injection pain.

Background:Propofol is one of common anesthetic drugs used in anesthesia. The most common side effects of propofol are local pain. Pretreatment with lidocaine can reduce propofol injection pain.Objectives:The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain.Patients and Methods:This was a double blind prospective clinical trial on children 4-8 years old with class ASA I and II candidates who were referred to Dr. Shaikh Hospital in Mashhad for elective surgery. Sample size calculated 50 patients in each groups based on pilot study. 100 children's were randomly divided equally in two groups, who were injected with lidocaine solutions 2% and 0.4% respectively. patient's pain evaluation based on VSD (verbal descriptor scale) and NRS (Numeric Rating Scale) using patient's verbal reaction and behavior namely fretting, hand drag and tearing. The collated data was analyzed.Results:There was nosignificant difference as to the first three variables (age, gender and weight P > 0.2). The significant difference regarding pain experience in both groups was noteworthy (P > 0.2).Conclusions:Most of the studies compared lidocaine with other drugs or its efficiency at different doses. Our study is different in that we applied a constant dose of lidocaine in various volumes and concentration. This result shows that lidocaine with the same does but lower concentration and higher volume is more effective in preventing propofol injection pain. Using diluted lidocaine with the dosage of 1 mg/kg and a concentration of 0.4% is an effective way to relieve pain caused by propofol injection in children.

Prevention of propofol injection pain: Comparison between lidocaine and ramosetron.

Background:Propofol causes a high incidence of pain during intravenous (IV) injection. The aim of this randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with IV ramosetron, used for prophylaxis of postoperative nausea and vomiting (PONV), would reduce propofol-induced pain as an equivalent to lidocaine.Materials and Methods:Hundred and twenty American Society of Anesthesiologists grade (ASA) I and II patients were randomly assigned into three groups (40 in each). Group N received 2 ml of 0.9% saline, Group L received 2 ml of lidocaine, and Group R received 2 ml of ramosetron. Mid forearm was occluded manually before injection and released after 1 min and then propofol was injected over 5 s. Patients were observed and questioned 15 s later if they had pain in the arm and pain was scored on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Unpaired Student's t-test and chi-square test/Fisher’ exact test were used to analyze results.Results:The incidence of pain in groups N, L, and R were 65, 35, and 30%, respectively. Pain was reduced significantly in the groups L and R (P < 0.05). Two patients each in Groups L and R (5% each) had moderate and severe pain. This difference in pain was statistically insignificant, but when compared to Group N (25 and 30%, respectively) it was statistically significant.Conclusion:Pretreatment with ramosetron 0.3 mg and lidocaine 40 mg are equally effective in preventing pain from propofol injection.

Prevention of propofol injection pain, using lidocaine in a large volume does it make a difference? A prospective randomized controlled double blinded study

PurposePropofol has become one of the most common anesthetic agents used for anesthesia because of its unique pharmacologic properties. Pain during bolus injection is a major drawback of propofol. The target of this study was to study the effect of lidocaine used in a large volume on prevention of propofol injection pain. Our hypothesis is that IV administration of diluted lidocaine in a large volume before propofol injection could be more effective in prevention of both immediate and delayed types of pain associated with propofol injection than the most commonly used method of mixing lidocaine with propofol (30 mg lidocaine/added to the 20 ml propofol syringe).Methods100 Patients with age range (20–60) years and classified ASA1 and ASA2 undergoing general anesthesia for elective surgery were included in this study. Patients were classified into two groups, the first (study) group, in which 30 mg lidocaine diluted into a total volume of 20 ml using normal saline was given IV after venous occlusion with rubber tourniquet followed by propofol injection. In the second (control) group, 30 mg lidocaine was mixed with propofol and given to the patient as commonly used.ResultsThis study showed a highly significant reduction in the propofol injection pain in the study group compared to the control group.Conclusionlidocaine when given diluted in a large volume after venous occlusion has dramatically reduced propofol injection pain in adults.

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

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.

Propofol enjeksiyon ağrısı önlenebilir mi?

Can propofol injection pain be avoided? Objective: The main purpose of this study is to investigate the most effective and reliable method for prevention of propofol injection pain. Material and Methods: In this prospective, randomized, double-blind trail we gave one of the six drugs of penthotal, lidocaine, saline, ketamine, ondansetron and decort by using wrist tourniquet. Then we evaluated arm withdrawn, grimace, verbal rating scale (VRS) and postoperative recall the pain during propofol injection. Results: Evaluation of VRS data between six groups revealed that the lidocaine group was the most painless group (86%). These findings were followed respectively by ondansetron (82%), decort (72%), penthotal (52%), ketamine (46%) and saline (12%).

Prevention of propofol-induced pain in children: pretreatment with small doses of ketamine

Study ObjectiveTo evaluate the efficacy of ketamine in preventing propofol injection pain in children. DesignProspective, randomized, double-blinded, placebo-controlled study. SettingUniversity-affiliated hospital. Patients192 ASA physical status 1 and 2 pediatric patients. InterventionsPatients were randomly assigned to 4 groups. Group S (control) received normal saline as a placebo; Group K1, Group K3, and Group K5 received 0.1 mg/kg, 0.3 mg/kg, and 0.5 mg/kg of ketamine, respectively. Fifteen seconds after the ketamine injection, patients were injected with propofol at a rate of 12 mL/min until loss-of-eyelash reflex. MeasurementPain was evaluated blindly at the time of induction using a 4-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Adverse effects were recorded. Characteristics of induction of anesthesia, such as dose of propofol and time from propofol injection to loss of consciousness (induction duration), were noted. Main Results39 (84.8%) Group S (control) patients had pain. Pretreatment with ketamine reduced the frequency of pain significantly to 56.5%, 17.0%, and 14.9% in Groups K1, K3, and K5, respectively. Furthermore, the frequency of moderate and severe pain in Group K1 (21.8%), Group K3 (6.4%), and Group K5 (4.3%) was significantly (P < 0.001, respectively) reduced compared with Group S (76.1%). Moreover, the dose of propofol for induction in Group K5 was smaller than in Group S, Group K1, and Group K3 (P < 0.05). One patient in Group K5 had emergence agitation. ConclusionPretreatment with a small dose of ketamine (0.3 mg/kg) reduced the frequency and intensity of propofol injection pain without severe adverse effects.

Prevention of Propofol Injection Pain in Children: A Comparison of Pretreatment with Tramadol and Propofol-Lidocaine Mixture

Background: The pain on propofol injection is considered to be a common and difficult to eliminate problem in children. In this study, we aimed to compare the efficacy of pretreatment with tramadol 1 mg.kg-1and propofol-lidocaine 20 mg mixture for prevention of propofol induced pain in children.Methods: One hundred and twenty ASA I-II patients undergoing orthopedic and otolaryngological surgery were included in this study and were divided into three groups with random table numbers. Group C (n=39) received normal saline placebo and Group T (n=40) received 1 mg.kg-1 tramadol 60 sec before propofol (180 mg 1% propofol with 2 ml normal saline) whereas Group L (n=40) received normal saline placebo before propofol-lidocaine mixture (180 mg 1% propofol with 2 ml %1 lidocaine). One patient in Group C was dropped out from the study because of difficulty in inserting an iv cannula. Thus, one hundred and nineteen patients were analyzed for the study. After given the calculated dose of propofol, a blinded observer assessed the pain with a four-point behavioral scale.Results: There were no significant differences in patient characteristics and intraoperative variables (p>0.05) except intraoperative fentanyl consumption and analgesic requirement one hr after surgery among the groups (p<0.05). Both tramadol 1 mg.kg-1 and lidocaine 20 mg mixture significantly reduced propofol pain when compared with control group. Moderate and severe pain were found higher in control group (p<0.05). The incidence of overall pain was 79.4% in the control group, 35% in tramadol group, 25% in lidocaine group respectively (p<0.001).Conclusions: Pretreatment with tramadol 60 sec before propofol injection and propofol-lidocaine mixture were significantly reduced propofol injection pain when compared to placebo in children.

Research on techniques of the prevention of propofol injection pain

Background Injection pain is a common adverse effect of propofol,not only enhances the tension of the patient,butalso breaks the smooth of the anesthesia.Objective We summarize the strategies of propofol in reducing injection pain.Content Mechanism involves stabilizing the cell membrane and changing the water phase concentration of propofol.Local or general anesthetics are applied.Dose or interval of the premedication differs.Combining medicine with physical method such as a tourniquet appears more effective.Trend Numerous methods to reduce propofol injection pain exhibit positive effects,but it still need to be improved.A simple and convenient way should be adopted in clinical use. Key words: Propofol; Injection pain; Prevention; Mechanism

Ketamine pretreatment with venous occlusion attenuates pain on injection with propofol

Ketamine pretreatment with venous occlusion attenuates pain on injection with propofol

The effects of alfentanil or remifentanil pretreatment on propofol injection pain

Study objective To compare the efficacy of alfentanil, remifentanil, and saline in minimizing the propofol injection pain. Design Randomized, double-blind study. Setting University hospital. Patients 175 ASA physical status I and II, adult female patients undergoing minor gynecological procedures with general anesthesia. Interventions Unpremedicated patients were randomly allocated to one of four groups. Patients received 2 mL (1 mg) of alfentanil (n = 43), 2 mL of remifentanil 0.01 mg (n = 43), 2 mL of remifentanil 0.02 mg (n = 45), or 2 mL of saline (n = 44) 30 seconds prior to administration 5 mL of propofol 1%. Measurements Patients were asked whether they had pain due to propofol injection. Their pain scores were evaluated with a Visual Analogue Scale. In the Postanesthesia Care Unit, frequency of postoperative nausea, vomiting, hypotension, and flushing were all determined. Main result The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than the saline group ( p < 0.05). When the alfentanil group was compared with the remifentanil groups, significant differences in pain relief associated with injection of propofol ( p < 0.001) were noted. Remifentanil 0.02 mg relieved pain associated with injection of propofol more effectively than remifentanil 0.01 mg ( p < 0.001). Conclusions The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than did the saline group. Remifentanil was effective in preventing propofol injection pain, and should be used at a dose of at least 0.02 mg for this purpose. Remifentanil may be an alternative drug for prevention of propofol injection pain.

Nitrous oxide/oxygen mixture and the prevention of pain during injection of propofol

Background and objective: The incidence of pain associated with the injection of propofol still remains a problem. This study sought to examine the analgesic effects of inhaled nitrous oxide in oxygen on the prevention of propofol injection pain. Methods: Nitrous oxide in oxygen was compared with a lidocaine (20 mg)-propofol mixture and with propofol alone (control) in a prospective, randomized, observer-blinded study. ASA I and II patients (n = 135) scheduled for elective surgical procedures were studied. A standard propofol injection technique and scoring system to measure the pain on injection was used. Results: Demographic variables were similar between the study groups. Without analgesia (control) 26 of 45 patients (58%) reported pain on injection compared with 11 of 45 patients (24%) in both the nitrous oxide (95% CI: 14-52%, P = 0.001) and lidocaine groups (95% CI: 14-52%, P = 0.001). Conclusions: The inhalation of a nitrous oxide/oxygen mixture significantly reduces the incidence of pain during propofol injection. This therapeutic stratagem was as effective as a lidocaine-propofol mixture.