Reducing Propofol Injection Pain Research Articles

Effect of ondansetron compared to lidocaine and placebo for reducing propofol injection pain: A systematic review and meta-analysis of randomized controlled trials.

Propofol is the most commonly used intravenous anesthetic medication and is most commonly associated with post-operative pain. Several drugs are investigated to reduce post-operative pain caused by propofol injection. Ondansetron is a potent anti-emetic drug showing promising results as an analgesic. This meta-analysis aims to compare the efficacy of ondansetron to placebo and lidocaine in reducing post-operative pain caused by propofol injection. PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched for relevant randomized controlled trials (RCTs) till May 2022. We conducted a meta-analysis using RevMan software version 5.4, and we assessed the quality of included RCTs using the Cochrane risk of bias tool. In our study, we included 23 RCTs with 2957 participants. Compared to placebo, ondansetron significantly increased the rate of no pain [risk ratio (RR) = 2.36, 95% confidence interval (CI) (1.39-4.01)], and reduced moderate [RR = 0.39, 95% CI (0.30-0.52)] and severe pain [RR = 0.34, 95% CI (0.24-0.50)]. Furthermore, ondansetron significantly reduced PONV [RR = 0.73, 95% CI (0.58, 0.91)]. On the other hand, ondansetron showed an inferior efficacy to lidocaine regarding the incidence of no, moderate, and severe pain. Ondansetron is effective in reducing post-operative propofol-induced pain. However, lidocaine is more effective than it.

Efficacy of Sufentanil and Lidocaine on Propofol Injection Pain

Background: Propofol injection pain is one of the shortcomings with this popular medication Objectives: This study explored the effects of lidocaine and sufentanil on propofol injection induced pain during induction of anesthesia and evaluation of the hemodynamic condition of the patients. Methods: In an interventional study on patients planned for elective ophthalmic surgeries, a 20-gauge intravenous catheter was used on the back of the hand. Based on medications administered before propofol injections, the patients were assigned into four groups: Group L: lidocaine 20 mg in 5 cc; Group S: sufentanil 5 μg in 5cc; Group C: sufentanil 5μg and lidocaine 20 mg in 5 cc, Group P: normal saline 5cc. 1/4 of the propofol total calculated dose (2.5mg/kg) was injected after 1 min and after opening of the tourniquet, flow rate was set 20 mg/sec. Subsequently, the pain was evaluated. Ultimately, atracurium 0.5mg/kg, fentanyl (2μg/kg), and the propofol remaining calculated dose were given parenterally. The hemodynamic status was recorded before and after the injection of propofol. Results: Two hundred patients participated in the study. Propofol injection pain was at the least in the C group followed by the L and S groups ranking next (C Conclusions: The use of sufentanil or lidocaine reduced propofol injection pain (compared to normal saline), but it was more effective if the combination of the both medications was used.

Pretreatment with Low-Dose Esketamine for Reduction of Propofol Injection Pain: A Randomized Controlled Trial.

Background Propofol-induced injection pain is a common adverse effect during the induction of general anesthesia. The purpose of this study is to investigate the effect of low-dose esketamine in preventing propofol injection pain. Methods In this double-blind, randomized, controlled trial, patients scheduled for elective ear surgery under general anesthesia received either normal saline (NS), or 40 mg lidocaine, or 0.15 mg/kg esketamine 30 seconds before manual injection of propofol. The primary outcome of this study was the incidence of propofol injection pain. The secondary outcomes included injection pain score, vital signs, total dosage of vasoactive drugs used within 5 minutes after induction, and adverse events related to drugs. Results A total of 105 patients were included. Compared with the NS group (67%), pretreatment with esketamine and lidocaine significantly reduced the incidence of injection pain to 29% and 33%, respectively (both P < 0.05); however, no significant difference was found between the esketamine and lidocaine groups. The median of injection pain score was significantly lower in the esketamine and lidocaine groups (both median (interquartile range) = 0 (0–1)) than that in the NS group (1 (0–2); P < 0.05). In addition, compared with the NS and lidocaine groups, preinjection esketamine provided more stable hemodynamic parameters within 5 minutes after induction (P < 0.05). No statistical difference was found in adverse events among the three groups. Conclusions Pretreatment with a low-dose esketamine can not only reduce the incidence of propofol injection pain but also provide a more stable circulation in patients after anesthesia induction. This convenient, well-tolerated, and economic treatment appears as an option to be routinely applied in clinic practice. Clinical Trial Registration. This trial is registered with https://www.chictr.org.cn/showproj.aspx?proj=136690 (the number for the trial registration isChiCTR2100052742).

Role of Low Dose Ketamine (0.05 and 0.1 Mg/Kg) in Alleviating Propofol Injection Pain

Introduction: Pain from propofol injection can be severe and distressing in some patients. Various methods and agents has been used to alleviate this pain. One of the agents is ketamine which has been used in different sub-anaesthetic doses to reduce propofol injection pain in comparison with different agents. None of the studies till date have used ketamine in dose less than 0.1 mg/kg. The aim of the present study was to compare ketamine in doses of 0.05 and 0.1 mg /kg to attenuate propofol injection pain. Material and Method: 48 ASA I and II adult patients undergoing different elective surgical procedures under general anaesthesia were randomised into 3 groups of 16 patients each. Group A patients received ketamine 0.05 mg/kg in 2 ml while group B patients received ketamine 0.1mg/kg in 2ml. Group C patients served as placebo control and were administered 2ml 0.9% normal saline intravenously. The venous drainage was occluded manually by rubber tourniquet at mid-arm. Subsequently the study drug or the placebo was administered as per group allocation. One minute later, 25 % of calculated propofol induction dose was injected over 5 seconds. VAS score for pain of propofol injection was assessed at 0, 1 and 2 minutes after the propofol injection. Thereafter, general anaesthesia technique was continued as per standard technique giving the remaining 75% of propofol. Patient’s heart rate and blood pressure were recorded at 0, 1 and 2 minutes after the administration of 25% of the calculated dose of propofol. Any evidence of hallucination was observed in the recovery room. Results: Demographic profile and the ASA grade of the patients in the 3 groups was uniformly distributed. The mean VAS score for pain perception in group B patients at 1 and 2 minutes was 0.56 and 1.06 respectively. In contrast, the mean VAS for pain was 3.88 and 5.06 at 1 and 2 minutes respectively in group C. The VAS score of patients belonging to group A was closer to that seen in group B patients. This difference in VAS score was statistically highly significant between the groups at 1 and 2 minutes. A significant fall in systolic blood pressure was noted at 2 minutes after administering 25% of the propofol induction dose in all the 3 groups. In contrast, no significant changes were noted at one minute when compared to baseline. There was insignificant fall in the heart rate at 1 and 2 minutes following the administration of 25 % propofol in group A and B. In contrast, an insignificant rise in heart rate was noted at 1 and 2 minutes in group C. Conclusion: The results of this study demonstrate that 0.01 mg/kg of ketamine administered one minute prior to propofol injection is effective and superior to 0.05 mg / kg of ketamine in relieving propofol injection pain without any side effects.

Effect of 6% hydroxyethyl starch pre-administration for reduction of pain on propofol injection: A placebo-controlled randomised study.

Background and Aims:Colloids modify the vascular endothelium and prevent contact activation of various substances. Pre-administration of colloids may prevent contact activation of vascular endothelium by propofol. The objective of this study was to evaluate the effect of 6% hydroxyethyl starch (HES) 130/0.4 pre-administration on propofol injection pain.Methods:Adult patients of the American Society of Anesthesiologists physical status I and II patients, 18-65 years old, of either gender and undergoing elective surgery were randomised into two groups. 100 mL bolus of HES or 0.9% normal saline (NS) was administered over three to five minutes through an 18 G cannula placed in the hand or forearm vein, followed by induction with 1% propofol premixed with 2% lidocaine. Pain during propofol injection was assessed every 10 seconds before the loss of verbal contact as 0- no pain; 1- mild pain evident only on questioning after 10 seconds without any obvious discomfort; 2-moderate pain self-reported by patients within 10 seconds with some discomfort; and 3- severe pain accompanied by withdrawing of hand, and behavioural signs.Results:126 patients completed the study. Overall incidence of pain was significantly higher in the NS group vs HES group (53% vs 28%; P = 0.004; relative risk 1.54, 95% confidence interval 1.13-2.09). Incidence of severe (8% vs 0%) and moderate pain (16% vs 5%) was higher in the NS group, while the incidence of mild pain was comparable (29% vs 23%; NS vs HES). A significant difference was seen in the severity of pain between the groups (P = 0.002).Conclusion:Pre-administration of 100 mL bolus of 6% HES 130/0.4 significantly reduced propofol injection pain.

A comparative study of efficacy of ketamine - propofol admixture and lignocaine - propofol admixture in reducing propofol injection pain in paediatric patients

A comparative study of efficacy of ketamine - propofol admixture and lignocaine - propofol admixture in reducing propofol injection pain in paediatric patients

Optimal dose of methylprednisolone for reduction of propofol injection pain: A randomized, double-blind, placebo controlled study

Introduction and Aims: Propofol (2,6-di-isopropylphenol) used for the induction of anaesthesia often causes mild to severe pain on injection, for which various methods have been tried, but with conflicting results. We designed a placebo-controlled, double-blind study to compare the efficacy of different doses of intravenous methylprednisolone for attenuation of propofol injection pain. Materials and Methods: One hundred twenty adult patients belonging to the American Society of Anaesthesiologists (ASA) physical Status II and III, between 21 and 60 years, scheduled for elective cardiac surgery, were divided into four groups: saline (group S, n=30), methylprednisolone 40mg (Group methylprednisolone 1 MP1, n=30), methylprednisolone 125mg (group methylprednisolone 2 MP2, n=30) and methylprednisolone 250mg (Group methylprednisolone 3 MP3, n=30) diluted into 2ml of distilled water. Study drugs were administered after tourniquet application and occlusion was released after 1 min and 1/4th of the total dose of propofol (2mg/kg) was administered at the rate of 0.5ml per second. Pain on propofol injection was assessed by four-point verbal rating scale. Statistical methods used included Chi-square test/Fisher’s exact test and Student’s t-test. Results: Demographic variables were similar among all the groups. The overall incidence of pain was 70% in the saline group, 53.33% in MP1 and 33.33% in both MP2 & MP3. Pain intensity was significantly less in patients receiving MP2 & MP3 drugs for pre-treatment than those receiving saline (P Conclusions: Pre-treatment with either 125mg or 250mg intravenous methylprednisolone was found to be effective in reducing propofol injection-induced pain. But pre-treatment with 250 mg MP itself was associated with pain during injection. Keywords: Methylprednisolone, Propofol, Pain.

Dexmedetomidine for prevention of propofol injection pain upon induction of anesthesia: a meta-analysis.

Propofol injection pain is a very common problem during the induction of general anesthesia. The purpose of this review is to evaluate the effectiveness of dexmedetomidine for the prevention of propofol injection pain so as to provide evidence for future clinical applications. PubMed, Embase, Cochrane library, and Google Scholar databases were searched for relevant randomized controlled trials examining the use of dexmedetomidine for the prevention of propofol injection pain. The pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) was calculated employing fixed-effects or random-effects models, depending upon the heterogeneity of the included trials. Because of the wide variety of interventions investigated, three comparisons of studies were established, dexmedetomidine compared with saline, lidocaine, and ketamine. Compared with saline, dexmedetomidine allowed more patients to experience no pain upon propofol injection (RR = 0.26, 95% CI (0.18, 0.38), P < 0.00001). Dexmedetomidine at doses of < 1μg/kg did not show superiority in relieving propofol injecting pain compared with lidocaine (RR = 1.28, 95% CI (0.82, 2.00), P = 0.04). Dexmedetomidine is less effective than ketamine in reducing pain on propofol injection with a statistically significant P value of < 0.000010 (RR = 1.93, 95% CI (1.51, 2.47)). The report of adverse effects is rare, dexmedetomidine is a safe method to reduce propofol injection pain. Pretreatment with dexmedetomidine may be a useful alternative for reducing pain on propofol injection, even though dexmedetomidine is less effective than lidocaine and ketamine.

Effect-site concentration of remifentanil for preventing propofol injection pain during induction of balanced anesthesia.

BackgroundDespite various strategies designed for preventing pain from propofol injection, it is still common and distressing to the patients. The purpose of the present study was to investigate the adequate effect-site concentration (Ce) of remifentanil to prevent pain due to propofol injection.MethodsA total of 160 adults scheduled for elective surgery were randomly assigned to one of four groups receiving normal saline (group S) or remifentanil at a Ce of 2 (group R2), 3 (group R3), or 4 ng/ml (group R4), administered via target-controlled infusion, followed by the injection of 2 mg/kg of propofol (delivered with 1% lipid propofol). The severity and incidence of injection pain were assessed on a four-point scale.ResultsThe incidence of propofol injection pain was significantly lower in group R2, R3, or R4 than in group S (30%, 5%, or 2.5% vs. 70%, respectively). Moreover, the intensity of the pain was lesser in group R2, R3, or R4 than in group S. However, the incidence or severity of injection was not different between groups R3 and R4.ConclusionsDuring the induction of balanced anesthesia using propofol injection, pretreatment with remifentanil at a target Ce of 3 ng/ml effectively reduced propofol injection pain in adults.

Efficacy of Intravenous Paracetamol in Combination with Lidocaine Pretreatment for Reducing Pain During Injection of Propofol

IntroductionThe association of pain and discomfort of moderate to high severity and a high incidence with the intravenous (IV) administration of propofol is well known. Various physical and pharmacological methods are used to minimize propofol-induced pain, but the best intervention is still unknown. Therefore, our aim was to determine the analgesic efficacy of IV paracetamol when used in combination with lidocaine pretreatment in reducing propofol injection pain.Materials and methodsThis double-blind, randomized controlled trial was conducted after receiving the approval of our institutional research ethics board. A total of 74 patients were included after providing informed consent, and participants were placed into two equal groups: group A received IV paracetamol (1 g) in combination with lidocaine pretreatment prior to the injection of propofol, and group B received lidocaine pretreatment alone prior to propofol injection. After propofol injection, all participants were asked to evaluate pain on the visual analog scale.ResultsPatients who received the lidocaine-paracetamol combination reported significantly more pain-free responses (51.35%) than those from patients who received lidocaine pretreatment alone (8.11%; P<0.05). The analgesic efficacy of group A was positive in 36 patients (97.3%), and for group B, the analgesic efficacy was positive in 24 patients (64.9%).ConclusionThe administration of IV paracetamol with lidocaine pretreatment was more effective than lidocaine pretreatment alone in reducing the pain caused by the injection of propofol. Physicians should consider using IV paracetamol in combination with lidocaine pretreatment when patients require IV propofol to ease patient suffering and reduce pain, which may help provide optimal patient care.

Clinical efficacy of 5-hydroxytryptamine 3 receptor antagonists in reducing propofol injection pain, postoperative nausea/vomiting and shivering: A meta-analysis

Abstract Objective To investigate the clinical efficacy of 5-hydroxytryptamine 3 (5-HT3) receptor antagonists in reducing propofol injection pain, postoperative nausea/ vomiting, and shivering through pooling the available published data. Methods Prospective randomized clinical studies relevant to 5-HT3 receptor antagonists in reducing propofol injection pain published before June 2019 were identified from four electronic databases, Pubmed, the Cochrane central register of controlled trials, EMBASE and Wanfang. The incidence of propofol injection pain, postoperative nausea/vomiting, and shivering in patients after 5-HT3 receptor antagonists were compared to relevant control groups by pooling the individual data through random or fixed-effect models. The publication bias was assessed by funnel plot and Egger’s line regression test. Results After screening, a total of 19 publications relevant to 5-HT3 receptor antagonists in reducing propofol injection pain and prevention of postoperative nausea/vomiting or shivering were included for analysis. The pooled results demonstrated that 5-HT3 receptor antagonists could significantly reduce the total propofol injection pain compared to placebo (RR=0.49, 95%CI:0.45-0.54, P&lt;0.05). For mild propofol injection pain, there was no statistical difference between 5-HT3 receptor antagonists and control groups (RR=1.07,95%CI:0.89-1.29, P&gt;0.05). However, for moderate (RR=0.37, 95%CI: 0.31-0.46, P&lt;0.05) and severe (RR=0.19, 95%CI:0.14-0.27, P&lt;0.05) propofol injection pain, the incidence in 5-HT3 receptor antagonists was significantly lower than that of control groups. The pooled results also indicated that incidence of postoperative nausea/vomiting (RR=0.28, 95%CI:0.17-0.44, P&lt;0.05) and postoperative shivering (RR=0.33, 95%CI:0.23-0.48, P&lt;0.05) were significantly reduced in 5-HT3 receptor antagonists group compared to control group with a statistical difference. Conclusion: In this meta-analysis, 5-HT3 receptor antagonists effectively reduced propofol injection pain, postoperative nausea/vomiting, and shivering.

A comparative study of 2 mg, 4 mg intravenous ondansetron and 2% lignocaine hydrochloride pre-treatment to alleviate pain of propofol injection

Introduction: Propofol belongs to one of the commonly used intravenous (IV)-inducing anaesthetic agents. However, at least 70% of the patients experience pain on propofol injection. To reduce pain, various methods were tried. A randomised, double-blinded comparative study was done by us. Materials and Methods: A total of 180 patients belonging to American Society of Anesthesiologists Grade 1 and 2, who were for elective or emergency surgery, were randomly divided into three groups. All surgeries were under general anaesthesia. Group 1 was administered 2 ml of 2% IV lignocaine, Group 2 was administered IV ondansetron 2 mg and Group 3 was administered IV ondansetron 4 mg. One-fourth of the total dosage was injected over 5 s, and pain was assessed in the patients during injection of propofol by verbal rating scale. Results: The intensity and incidence of pain were comparatively less with lignocaine and ondansetron 4 mg overall. Even though there was better relief of pain with lignocaine, ondansetron 4 mg along with venous occlusion also reduced propofol injection pain. Conclusion: Ondansetron also can be used as an alternative in relief of pain on propofol injection just like lignocaine.

INJECTION PAIN OF PROPOFOL IN CHILDREN WITH MEDIUM PLUS LONG CHAIN TRIGLYCERIDES AND LONG CHAIN PROPOFOL MIXED WITH LIGNOCAINE

Introduction: Propofol is widely accepted drug because of its rapid and smooth induction, short context-sensitive time, rapid terminal half-life time and low incidence of postoperative nausea and vomiting. It is used for sedation and anaesthesia for almost all types of surgeries. During a propofol injection, pain due to the long-chain triglyceride (LCT) emulsion is experienced by 70% of adults and up to 85% of children. Despite various strategies to reduce propofol injection pain, this still poses a clinical problem in adults and children, and the incidence reported to be 30–90%. A medium-chain triglyceride/long-chain triglyceride (MCT/LCT) emulsion has been advised to reduce injection pain as compared to propofol LCT in adults and teenagers&#x0D; Material and Methods: 100 children aged 5–13 years, in American Society Anaesthesiologists (ASA) class I or II, undergoing elective general anaesthesia without any contraindication to propofol anaesthesia were included in the study. Injection pain following injection propofol was assessed in all patients, but the anaesthetist was blinded for which formula was being used.&#x0D; Results: The demographic characteristics like age, sex, weight, amount of propofol given, ASA physical status and recovery period was calculated. No statistically significant difference was observed in both the groups. Incidence of pain and severe pain in LCT group was 24 (48%) and 7 (14%) respectively while incidence of pain and severe pain in MCT/LCT group was 15 (30%) and 1 (2%) respectively. Pain score was found less in group MCT / LCT.&#x0D; Conclusion: Medium plus long chain triglycerides and long chain propofol along with lignocaine significantly reduces the incidence as well as the severity of injection pain in the paediatric age group and can be used in children for sedation or induction of anaesthesia.

Effect of low dose ketamine pretreatment on propofol injection pain: A randomised double blind, controlled trial

Introduction: Propofol being the most commonly used induction agent for general anaesthesia causes pain on injection as a side effect with an incidence of 28-90%. Ketamine is one of the drugs that have shown to reduce the incidence and severity of pain. The study aimed to know the efficacy of ketamine at 2 different doses on propofol injection pain. Materials and Methods: After institutional ethical committee clearance and written informed consent 90 adult patients of ASA grade I/II aged between 20-60 years scheduled for various elective surgical procedures under general anaesthesia were randomly divided into 3 groups as group K100, group K200 and group S. Group K100 and K200 received 100 and 200µg/kg iv ketamine respectively and group S received 2ml normal saline over 15 seconds just before the injection of propofol over 30 seconds. Incidence of pain and its severity was measured in each patient using verbal rating scale as 0-3 grade while injecting propofol corresponding to no, mild, moderate, severe pain. Hemodynamic parameters were also recorded at specific time intervals. Data was collected and analyzed using appropriate statistical tests. Results: The demographic data had no statistical difference among the groups. The incidence of pain in group K100, K200 and group S was 50%, 23.3%, 83.3% respectively which was significant statistically with P Conclusion: Premedication with ketamine is a simple safe effective method to reduce propofol injection pain. 200µg/kg decreases the incidence and severity more effectively. Keywords: Propofol, Pain, Ketamine, Premedication.

Premedication with oral paracetamol for reduction of propofol injection pain: a randomized placebo-controlled trial

BackgroundTo compare the effect of premedication with 2 different doses of oral paracetamol to prevent pain at propofol intravenous injection.MethodsWe conducted a double-blind randomized controlled trial in which patients scheduled for induction of general anesthesia with intravenous propofol received either a placebo, 500 mg or 1000 mg of oral paracetamol (P500 and P1000, respectively) 1 h prior to induction. Two mg/kg of propofol was injected at a rate of 600 ml/hr. After 1/4 of the full dose had been injected, the syringe pump was paused, and patients were asked to rate pain at the injection site using a verbal numerical rating score (VNRS) from 0 to 10.ResultsThree hundred and twenty-four patients were included. Pain intensity was lower in both P500 and P1000 groups (median VNRS [interquartile range] = 2 [0–3] and 4 [2–5], respectively) than in the placebo group (8 [7–10]; P < 0.001)*. The rate of pain was lower in the P1000 group (70.4%) than in both the P500 and the placebo group (86.1 and 99.1%, respectively; P < 0.001)*. The respective rates of mild (VNRS 1–3), moderate (VNRS 4–6) and severe pain (VNRS 7–10) were 47.2, 23.2 and 0% in the P1000 group, 28.7, 50 and 7.4% in the P500 group, and 0, 22.2 and 76.9% in the placebo group (P < 0.001* for between group comparisons). Tolerance was similar in the 3 groups.ConclusionsA premedication with oral paracetamol can dose-dependently reduce pain at propofol intravenous injection. To avoid this common uncomfortable concern for the patients, this well-tolerated, available and cheap treatment appears as an option to be implemented in the current practice.Trial registrationTCTR20150224002. Prospectively registered on 24 February 2015.

Comparison of different doses of Injection Cisatracurium to establish optimal dose for reduction of propofol injection pain

Comparison of different doses of Injection Cisatracurium to establish optimal dose for reduction of propofol injection pain

Low Dose Ketamine in Prevention of Propofol Injection Pain

Background: Propofol is the most widely used intravenous anesthetic agent for induction and maintenance of anesthesia as well as for sedation inside and outside operation theatre. Propofol is almost an ideal intravenous (IV) anesthetic agent, but pain on its injection still remain a problem. Pain may not be a serious complication, but most patients remember it as one of the unpleasant encounters with anesthetists. In one survey pain on propofol injection stands seventh most important problem in the current practice of clinical anesthesia. Ketamine is (NMDA) receptor antagonist agent and a dissociative anesthetic with neurostimulatory side effect, multiple research trials suggest ketamine as a strong analgesic agent in sub anesthetic IV doses. Objective: The aim of the current study was to prove the effectiveness of low dose ketamine in preventing propofol injection pain. Methodology: Two groups each included 60 patients (middle age females who performed ovum pick up surgery: Ketamine group 60 patient received ketamine 0.2 mg/kg with propofol. Saline group 60 patient received normal saline 10 ml with propofol. Results: In the current study pain and hemodynamic changes (BP, pulse) were observed. Regarding pain: The incidence of propofol injection pain in the current study was reduced from 93.2% in saline group to 55% in ketamine group, the incidence of severe pain was completely abolished with ketamine. Regarding hemodynamics: There was no statistical significance between both groups regarding heart rate, regarding BP the degree of drop in BP in ketamine group was to less extent than in saline group that proves the role of ketamine in hemodynamic stability. Conclusion: Finally ketamine in low dose was effective in reduction of propofol injection pain.

Hyoscine N-Butylbromide for Preventing Propofol Injection Pain: A Randomized, Placebo-Controlled and Double-Blind Study

Objective: In this study, the aim was to investigate the effect of hyoscine N-butylbromide (HnBB) pretreatment on pain during propofol injection. Subjects and Methods: In this prospective, randomized, placebo-controlled and double-blind trial, 60 patients scheduled to undergo routine outpatient surgery under general anesthesia were randomly allocated to 2 groups, the HnBB (n = 30) and sodium chloride (n = 30) groups. Twenty seconds after the injection of 20 mg HnBB or 0.9 % sodium chloride, a 50-mg dose of propofol was injected in 2–3 s. Ten seconds later, the pain intensity was assessed using a 4-point scale: no pain (0), mild (1), moderate (2), and severe (3) pain. The Student t test was used for the analysis of parametric data and the Pearson χ² test for categorical data. Results: The occurrence of pain in the HnBB group (43.3%) was significantly lower than the control group (73.3%) (p < 0.018). Of the 30 patients in each group, 10 in the control group and 3 in the HnBB group experienced severe pain (p = 0.001). Conclusions: Pretreatment with 20 mg HnBB significantly reduced propofol injection pain compared to placebo.

Intravenous Lidocaine Alleviates the Pain of Propofol Injection by Local Anesthetic and Central Analgesic Effects.

Lidocaine alleviates propofol injection pain. However, whether lidocaine works through a local anesthetic effect at the site of intravenous injection or through a systemic effect on the central nervous system remains unknown. This study aimed to determine the pain-alleviating mechanism of lidocaine. A randomized controlled study. A gastroscopy facility. The study was divided into two parts. Part 1 involved 717 patients who were randomly assigned into five groups. Groups PR, RL20, and RL40 received normal saline or saline containing 20 or 40 mg of lidocaine, injected via the vein on the right hand. Groups LL20 and LL40 received 20 or 40 mg of lidocaine, injected via the vein on the left hand. Part 2 involved 378 patients who were randomly assigned into five groups. Groups RL40, RL1.2, and RL1.5 received 40 mg, 1.2 mg/kg, and 1.5 mg/kg of lidocaine, injected via the vein on the right hand. Groups LL1.2 and LL1.5 received 1.2 or 1.5 mg/kg of lidocaine, injected via the vein on the left hand. All received 2 mg/kg of propofol via the vein on the right hand two minutes later. Injection pain and patient satisfaction were recorded. The incidence of pain of group RL40 was lower than that of group PR. The incidence of pain of group LL1.2 was higher than that of other groups. A dosage of 40 mg lidocaine is an appropriate dosage to alleviate propofol injection pain within the same vein. Lidocaine reduces propofol injection pain through both a local anesthetic effect and a central analgesic effect when the dosage reaches 1.5 mg/kg.

Reducing propofol injection pain by pretreatment with tramadol and butorphanol: Are they safe?

Reducing propofol injection pain by pretreatment with tramadol and butorphanol: Are they safe?