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Preventing pain during injection of propofol: effects of a new emulsion with lidocaine addition

Published online by Cambridge University Press:  07 July 2006

B. Bachmann-Mennenga ,
A. Ohlmer ,
R. Hasso Boedeker ,
M. Mann ,
B. Mühlenbruch  and
M. Heesen
B. Bachmann-Mennenga
Affiliation:
Klinikum Minden, Department of Anaesthesiology, Minden, Germany
A. Ohlmer
Affiliation:
Klinikum Minden, Department of Anaesthesiology, Minden, Germany
R. Hasso Boedeker
Affiliation:
University of Giessen, Department of Biometrics, Giessen, Germany
M. Mann
Affiliation:
University of Giessen, Department of Biometrics, Giessen, Germany
B. Mühlenbruch
Affiliation:
Klinikum Minden, Department of Anaesthesiology, Minden, Germany
M. Heesen
Affiliation:
Klinikum Bamberg, Department of Anaesthesiology, Bamberg, Germany
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Summary

Background and objective: Previous studies found that lidocaine addition to propofol long-chain triglyceride was associated with a lower incidence of injection pain than medium-chain triglyceride/long-chain triglyceride formulation, but the incidence was still high (31–40%). Our study investigated whether the incidence of injection pain could be further reduced by the addition of lidocaine (10 mg, 20: 1) to propofol medium-chain triglyceride/long-chain triglyceride. Methods: In a randomized double-blind controlled trial 464 patients scheduled to undergo regional anaesthesia were assigned to receive one of the following four options: propofol medium-chain triglyceride/long-chain triglyceride + lidocaine, propofol long-chain triglyceride +lidocaine, propofol medium-chain triglyceride/long-chain triglyceride or propofol long-chain triglyceride. Propofol was injected to reach grade 3 of the Observer’s Assessment of Alertness/Sedation scale. Results: Incidence of injection pain was 18% in the propofol medium-chain triglyceride/long-chain triglyceride +lidocaine group, 31% in the propofol long-chain triglyceride +lidocaine group, 47% in the propofol medium-chain triglyceride/long-chain triglyceride group and 60% in the long-chain triglyceride group. Propofol medium-chain triglyceride/long-chain triglyceride + lidocaine was associated with a statistically significant reduced incidence of injection pain compared with propofol long-chain triglyceride +lidocaine ( P =0.0249, number needed to treat =7.7). Conclusions: Premixing propofol medium-chain triglyceride/long-chain triglyceride with lidocaine is one of the most effective measures currently available to reduce the incidence of injection pain in sedated patients during regional anaesthesia.

Keywords

ANAESTHETICS, INTRAVENOUS, propofolPAIN ACUTE AND POSTOPERATIVELOCAL ANAESTHETIC AGENTS, lidocaineDRUG FORMULATION
Type
Origina Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 1 , January 2007 , pp. 33 - 38
Copyright
© 2006 European Society of Anaesthesiology

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References

Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005–1043.Google Scholar
Picard P, Tramer MR. Prevention of pain on injection with propofol. A quantitative systematic review. Anesth Analg 2000; 90: 953–959.Google Scholar
Bachmann-Mennenga B, Ohlmer A, Heesen M. Incidence of pain after intravenous injection of medium-/long-chain triglyceride emulsion of propofol: an observational study in 1375 patients. Arzneimittelforschung/Drug Res 2003; 53: 621–626.Google Scholar
Ho CM, Tsou MY, Sun MS, Chu CC, Lee TY. The optimal effective concentration of lidocaine to reduce pain on injection of propofol. J Clin Anesth 1999; 11: 296–300.Google Scholar
Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg 1996; 82: 469–471.Google Scholar
Agarwal A, Raza M, Dhiraaj S et al. Pain during injection of propofol: the effect of prior administration of butorphanol. Anesth Analg 2004; 99: 117–119.Google Scholar
Basaranoglu G, Erden V, Delatioglu H, Saitoglu L. Reduction of pain on injection of propofol using meperidine and remifentanil. Eur J Anaesthesiol 2005; 22: 890–892.Google Scholar
Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia 1998; 53: 302–305.Google Scholar
Ozkocak I, Altunkaya H, Ozer Y, Ayoglu H, Demirel CB, Cicek E. Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction. Eur J Anaesthesiol 2005; 22: 44–48.Google Scholar
Memis D, Turan A, Karamanhoglu B, Süt N, Pamukcu Z. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg 2002; 95: 606–608.Google Scholar
Iwama H, Nakane M, Ohmori S et al. Nafamostat mesilate, a kallikrein inhibitor, prevents pain on injection with propofol. Br J Anaesth 1998; 81: 963–964.Google Scholar
Parmar AK, Koay CK. Pain on injection of propofol. A comparison of cold propofol with propofol premixed with lignocaine. Anaesthesia 1998; 53: 79–88.Google Scholar
Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991; 67: 281–284.Google Scholar
Graupers A, Liljeroth E, Akeson J. Propofol infusion rate does not affect local pain on injection. Acta Anaesthesiol Scand 2002; 46: 361–363.Google Scholar
Shimizu T, Inomata S, Kihara S, Toyooka H, Brimacombe JR. Rapid injection reduces pain on injection with propofol. Eur J Anaesthesiol 2005; 22: 394–396.Google Scholar
Babl J, Doenicke AW, Mönch A. New formulation of propofol in an LCT/MCT emulsion. Approach to reduce pain on injection. Eur Hosp Pharm 1995; 1: 15–21.Google Scholar
Doenicke AW, Roizen MF, Rau J et al. Pharmacokinetics and pharmacodynamics of propofol in a new solvent. Anesth Analg 1997; 85: 1399–1403.Google Scholar
Larsen B, Beerhalter U, Biedler A et al. Less pain on injection by a new formulation of propofol? A comparison with propofol LCT. Anaesthesist 2001; 50: 842–845.Google Scholar
Rau J, Roizen MF, Doenicke AW, O'Connor MF, Strohschneider U. Propofol in an emulsion of long- and medium-chain triglycerides: the effect on pain. Anesth Analg 2001; 93: 382–384.Google Scholar
Röhm KD, Piper SN, Schööhorn TAH, Suttner SW, Maleck WH, Boldt J. Injection pain secondary to Propofol-MCT/LCT and Propofol-LCT – comparison of prophylaxis with lidocaine. Anästhesiol Intens Notfallmed Schmerzther 2003; 38: 643–647.Google Scholar
Kunitz O, Lösing R, Schulz-Stübner S, Haaf-von-Below S, Rossaint R, Kuhlen R. Propofol-LCT versus Propofol-MCT/LCT with or without Lidocaine – a comparison on pain on injection. Anästhesiol Intens Notfallmed Schmerzther 2004; 39: 10–14.Google Scholar
Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: a randomized, controlled, double-blinded study. Anesth Analg 1999; 89: 197–199.Google Scholar
Chernik DA, Gillings D, Laine H et al. Validity and reliability of the observers assessment of alertness/seda scale: study with intravenous midazolam. J Clin Psychopharmacol 1990; 10: 244–251.Google Scholar
Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999; 88: 1085–1091.Google Scholar
Morishima T, Sobue K, Arima H, Tanaky S, So MH, Ando H. Profound pain due to propofol injection triggered myocardial ischemia in a patient with a suspected pheochromocytoma. Anesth Analg 2003; 96: 631.Google Scholar
Cicek M, Koroglu A, Demirbilek S, Teksan H, Ersoy MO. Comparison of propofol-alfentanil and propofol-remifentanil anaesthesia in percutaneous nephrolithotripsy. Eur J Anaesthesiol 2005; 22: 683–688.Google Scholar
Fulton B, Sorkin EM. Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs 1995; 50: 636–657.Google Scholar
Liljeroth E, Akeson J. Less local pain on intravenous infusion of a new propofol emulsion. Acta Anaesthesiol Scand 2005; 49: 248–251.Google Scholar
Adam S, van Bommel J, Pelka M, Dirckx M, Jonsson D, Klein J. Propofol-induced injection pain: comparison of a modified propofol emulsion to standard propofol with premixed lidocaine. Anesth Analg 2004; 99: 1076–1079.Google Scholar
Schaub E, Kern C, Landau R. Pain on injection: a double-blind comparison of propofol with lidocaine pretreatment versus propofol formulated with long- and medium-chain triglycerides. Anesth Analg 2004; 99: 1699–1702.Google Scholar
Eriksson M, Englesson S, Niklasson F, Hartvig P. Effect of lignocaine and pH on propofol-induced pain. Br J Anaesth 1997; 78: 502–506.Google Scholar
Yew WS, Chong SY, Tan KH, Goh MH. The effects of intravenous lidocaine on pain during injection of medium- and long-chain triglyceride propofol emulsions. Anesth Analg 2005; 100: 1693–1695.Google Scholar
Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492–494.Google Scholar
Shimizu T, Inomata S, Kihara S, Toyooka H, Brimacombe JR. Rapid injection reduces pain on injection with propofol. Eur J Anaesthesiol 2005; 22: 394–396.Google Scholar