Pain on Injection of Propofol: Efficacy of Paracetamol and Lidocaine

DOI: 10.4236/ojanes.2014.44013   PDF   HTML     4,429 Downloads   6,618 Views   Citations

Abstract

Background and Objectives: Propofol remains the most common drug for induction of general anaesthesia, although it causes considerable pain on injection. None of the commonly used methods completely attenuate this discomfort. We aimed to investigate the effect of i.v. paracetamol pretreatment on the propofol injection pain. Materials and Methods: A prospective randomized double-blind study was conducted on 180 patients, ASA I or II status, scheduled to undergo elective surgery. They were randomly assigned to one of the three groups of 60 each. Groups I, II, III were pretreated with 40 mg of lidocaine in saline, 100 mg of paracetamol and 10 ml of saline, respectively. All patients had an 18-gauge catheter inserted into a superficial radial vein. After 2 min of venous occlusion, one-fourth of the total propofol dose was injected into the vein over a period of 20 seconds. During the injection of both pretreatment solution and propofol, a blinded researcher assessed the patient’s pain level using a four-point verbal rating scale (VRS) (none = 0, mild = 1, moderate = 2, and severe = 3). X2 test and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P < 0.05. Results: The three groups were comparable in respect to patient’s characteristics. The incidence of pain on injection of propofol in placebo, i.v. paracetamol and lidocaine groups were 85%, 36%, 21% respectively (p < 0.05). Intensity and severity of propofol induced pain were comparable between paracetamol and lidocaine groups. Conclusion: Pretreatment using i.v. paracetamol was found to be effective in reducing propofol injection-induced pain.

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Khouadja, H. , Arnous, H. , Tarmiz, K. , Beletaifa, D. , Brahim, A. , Brahem, W. , Sakhri, J. and Jazia, K. (2014) Pain on Injection of Propofol: Efficacy of Paracetamol and Lidocaine. Open Journal of Anesthesiology, 4, 81-87. doi: 10.4236/ojanes.2014.44013.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Abdo El Hamd, M. (2013) The Clinical Pharmacology of Propofol: A Brief Review. Open Journal of Anesthesiology, 3, 367-373. http://dx.doi.org/10.4236/ojanes.2013.38078
[2] Tan, C.H. and Onsiong, M.K. (1998) Pain on Injection of Propofol. Anaesthesia, 53, 468-476.
http://dx.doi.org/10.1046/j.1365-2044.1998.00405.x
[3] Kim, K., Kim, Y.S., Lee, D.K., Lim, B.G., Kim, H.Z., Kong, M.H., Kim, N.S. and Lee, I.O. (2013) Reducing the Pain of Microemulsion Propofol Injections: A Double-Blind, Randomized Study of Three Methods of Tourniquet and Lidocaine. Clinical Therapeutics, 35, 1734-1743. http://dx.doi.org/10.1016/j.clinthera.2013.09.018
[4] Jalota, L., Kalira, V., George, V.E., Shi, Y.Y., Hornuss, C., Radke, O., Pace, N.L. and Apfel, C. (2011) Prevention of Pain on Injection of Propofol: Systematic Review and Meta-Analysis. British Medical Journal, 342, d1110.
http://dx.doi.org/10.1136/bmj.d1110
[5] Lee, S.K. (2010) Pain on Injection with Propofol. Korean Journal of Anesthesiology, 59, 297-298.
http://dx.doi.org/10.4097/kjae.2010.59.5.297
[6] Ahmad, S., De Oliveira Jr., G.S., Fitzgarald, P.C. and McCarthy, R.J. (2013) The Effect of Intravenous Dexamethasone and Lidocaine on Propofol-Induced Vascular Pain: A Randomized Double-Blinded Placebo-Controlled Trial. Pain Research and Treatment, 2013, Article ID: 734531.
[7] Madenoglu, H., Yildiz, K., Dogru, K. and Boyaci, A. (2003) Efficacy of Different Doses of Lidocaine in the Prevention of Pain Due to Propofol Injection: A Randomized, Open-Label Trial in 120 Patients. Current Therapeutic Research, 64, 310-316. http://dx.doi.org/10.1016/S0011-393X(03)00066-3
[8] Kaya, S., Turhanoglu, S., Karaman, H., Ozgiin, S. and Basak, N. (2008) Lidocaine for Prevention of Propofol Injection-Induced Pain: A Prospective, Randomized, Double-Blind, Controlled Study of the Effect of Duration of Venous Occlusion with a Tourniquet in Adults. Current Therapeutic Research, 69, 29-35.
http://dx.doi.org/10.1016/j.curtheres.2008.02.005
[9] Borazan, H., Erdem, T.B., Kececioglu, M. and Otelcioglu, S. (2010) Prevention of Pain on Injection of Propofol: A Comparison of Lidocaine with Different Doses of Paracetamol. European Journal of Anaesthesiology, 27, 253-257.
http://dx.doi.org/10.1097/EJA.0b013e328330eca2
[10] Anderson, B.J. (2008) Paracetamol (Acetaminophen): Mechanisms of Action. Pediatric Anesthesia, 18, 915-921.
http://dx.doi.org/10.1111/j.1460-9592.2008.02764.x
[11] Macario, A., Weinger, M., Carney, S. and Kim, A. (1999) Which Clinical Anesthesia Outcomes Are Important to Avoid? The Perspective of Patients. Anesthesia and Analgesia, 89, 652-658.
[12] Sim, J.Y., Lee, S.H., Park, D.Y., Jung, J.A., Ki, K.H., Lee, D.H. and Noh, G.J. (2009) Pain on Injection with Microemulsion Propofol. British Journal of Clinical Pharmacology, 67, 316-325.
http://dx.doi.org/10.1111/j.1365-2125.2008.03358.x
[13] Ando, R. and Watanabe, C. (2005) Characteristics of Propofol-Evoked Vascular Pain in Anaesthetized Rats. British Journal of Anaesthesia, 95, 384-392. http://dx.doi.org/10.1093/bja/aei184
[14] Wallentine, C.B., Shimode, N., Egan, T.D. and Pace, N.L. (2011) Propofol in a Modified Cyclodextrin Formulation: First Human Study of Dose—Response with Emphasis on Injection Pain. Anesthesia and Analgesia, 113, 738-741.
[15] Yamakage, M., Iwasaki, S., Satoh, J.I. and Namiki, A. (2005) Changes in Concentrations of Free Propofol by Modification of the Solution. Anesthesia and Analgesia, 101, 385-388.
http://dx.doi.org/10.1213/01.ANE.0000154191.86608.AC
[16] Baker, M.T. and Naguib, M. (2005) Propofol: The Challenges of Formulation. Anesthesiology, 103, 860-876.
http://dx.doi.org/10.1097/00000542-200510000-00026
[17] Kam, E., Abdul-Latif, M.S. and McCluskey, A. (2004) Comparison of Propofol-Lipuro with Propofol Mixed with Lidocaine 10 mg on Propofol Injection Pain. Anaesthesia, 59, 1167-1169.
http://dx.doi.org/10.1111/j.1365-2044.2004.03964.x
[18] Le Guen, M., Grassin-Delyle, S., Cornet, C., Genty, A., Chazot, T., Dardelle, D., Liu, N., Dreyfus, J.F., Mazoit, J.X., Devillier, P., Alvarez, J.C., Sessler, D.I. and Fischler, M. (2014) Comparison of the Potency of Different Propofol Formulations: A Randomized, Double-Blind Trial Using Closed-Loop Administration. Anesthesiology, 120, 355-364.
[19] Tarmiz, K., Ferhi, F., Toumi, M., Slama, A. and BenJazia, K. (2009) Efficacicité d’une faible dose de kétamine dans la réduction de la douleur liée à l’injection de propofol. Annales Française Anesthésie Réanimation, 28, 177-178.
http://dx.doi.org/10.1016/j.annfar.2008.12.014
[20] Kim, H.S., Cho, K.R., Lee, J.H., Kim, Y.H., Lim, S.H., Lee, K.M., Cheong, S.H., Kim, Y.J., Shin, C.M. and Lee, J.Y. (2010) Prevention of Pain During Injection of Microemulsion Propofol: A Lication of Lidocaine Mixture and the Optimal Dose of Lidocaine. Korean Journal of Anesthesiology, 59, 310-313. http://dx.doi.org/10.4097/kjae.2010.59.5.310
[21] Sasaki, T., Okamura, S. and Kisara, A. (1999) Effect of Lidocaine on Pain Caused by Injection of Propofol: Comparison of Three Methods at Two Injection Rates. Journal of Anesthesia, 13, 14-16.
http://dx.doi.org/10.1007/s005400050015
[22] Picard, P. and Tramèr, M.R. (2000) Prevention of Pain on Injection with Propofol: A Quantitative Systematic Review. Anesthesia & Analgesia, 90, 963-969. http://dx.doi.org/10.1213/00000539-200004000-00035
[23] Lee, Y.S., Kim, H., Brahim, J.S., Rowan, J., Lee, G. and Dionne, R.A. (2007) Acetaminophen Selectively Suppresses Peripheral Prostaglandin E2 Release and Increases COX-2 Gene Expression in a Clinical Model of Acute Inflammation. Pain, 129, 279-286. http://dx.doi.org/10.1016/j.pain.2006.10.020
[24] Canbay, O., Celebi, N., Arun, O., Karagöz, A.H., Saricaoglu, F. and Özgen, S. (2008) Efficacy of Intravenous Acetaminophen and Lidocaine on Propofol Injection Pain. British Journal of Anaesthesia, 100, 95-98.
http://dx.doi.org/10.1093/bja/aem301
[25] Ozkan, S., Sen, H., Sizlan, A., Yanarates, O., Mutlu, M. and Dagli, G. (2011) Comparison of Acetaminophen (with or without Tourniquet) and Lidocaine in Propofol Injection Pain. Bulletin of Clinical Psychopharmacology, 21, 100-104.
http://dx.doi.org/10.5455/bcp.20110408022041

  
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