Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-27T10:52:09.792Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of diphenhydramine and lidocaine for prevention of pain after injection of propofol: a double-blind, placebo-controlled, randomized study

Published online by Cambridge University Press:  01 March 2007

S. Apiliogullari ,
B. Keles ,
B. Apiliogullari ,
M. Balasar ,
H. Yilmaz  and
A. Duman
S. Apiliogullari
Affiliation:
Ozel Konya Hospital, Department of Anaesthesia and Intensive Care, Turkey
B. Keles
Affiliation:
Selcuk University, Medical Faculty, Department of Otorhinolaryngology, Turkey
B. Apiliogullari
Affiliation:
Meram Teaching & Research Hospital, Department of Thoracic Surgery, Turkey
M. Balasar
Affiliation:
Ozel Konya Hospital, Department of Urology, Turkey
H. Yilmaz
Affiliation:
Ozel Konya Hospital, Department of General Surgery, Turkey
A. Duman
Affiliation:
Selcuk University, Medical Faculty, Department of Anaesthesia and Intensive Care, Konya, Turkey
Get access

Summary

Background and objective

Pain on injection is still a problem with propofol. The purpose of the study was to compare the effectiveness of diphenhydramine and lidocaine on pain caused by propofol at the site of injection.

Methods

One hundred and eighty ASA I–II adults undergoing elective surgery were randomly assigned into three groups of 60 each. Group I (placebo) received 2 mL normal saline, Group II received 2 mL (40 mg) 2% lidocaine and Group III received 2 mL (20 mg) diphenhydramine intravenously (i.v.) during a 1-min venous occlusion, followed by propofol into a cephalic forearm vein of the antecubital fossa. Pain assessment was made immediately after propofol injection.

Results

In the placebo group 25 (41.7%) patients experienced pain during propofol injection as compared to 2 (3.3%) and 3 (5.0%) in the lidocaine and diphenhydramine groups, respectively. The prevalence of pain and pain score were significantly less in both the lidocaine and diphenhydramine groups than in the placebo group (P= 0.00). No difference was found between the diphenhydramine and lidocaine groups (P = 0.60).

Conclusion

Previous injection of diphenhydramine with venous occlusion can be considered as an alternative to lidocaine for reducing the prevalence of pain caused by injection of propofol into peripheral veins.

Keywords

PROPOFOLLIDOCAINEDIPHENHYDRAMINEINJECTIONS INTRAVENOUS, adverse effects, pain
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 235 - 238
Copyright
Copyright © European Society of Anaesthesiology 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Picard, P, Tràmer, MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–969.Google Scholar
2.Marik, PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des 2004; 10: 3639–3649.CrossRefGoogle ScholarPubMed
3.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 ScholarPubMed
4Tan, CH, Onsiong, MK. Pain on injection of propofol. Anaesthesia 1998; 53: 468–476.CrossRefGoogle ScholarPubMed
5.Meyer, RA, Jakubowski, W. Use of tripelennamine and diphenhydramine as local anesthetics. J Am Dent Assoc 1964; 69: 112–117.Google Scholar
6.Sasaki, T, Okamura, S, Kisara, A et al. . Effect of lidocaine on pain caused by injection of propofol: comparison of three methods at two injection rates. J Anesth 1999; 13: 14–16.Google Scholar
7.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
8.Yamakage, M, Iwasaki, S, Satoh, J, Namiki, A. Changes in concentrations of free propofol by modification of the solution. Anesth Analg 2005; 101: 385–388.CrossRefGoogle ScholarPubMed
9.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
10.Scott, RP, Saunders, DA, Norman, J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492–494.CrossRefGoogle ScholarPubMed
11.McCrirrick, A, Hunter, S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia 1990; 45: 443–444.CrossRefGoogle ScholarPubMed
12.King, SY, Davis, FM, Wells, JE, Murchison, DJ, Pryor, PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992; 74: 246–249.CrossRefGoogle ScholarPubMed
13.Tan, LH, Hwang, NC. The effect of mixing lidocaine with propofol on the dose of propofol required for induction of anesthesia. Anesth Analg 2003; 97: 461–464.Google Scholar
14.Masaki, Y, Tanaka, M, Nishikawa, T. Physicochemical compatibility of propofol-lidocaine mixture. Anesth Analg 2003; 97: 1646–1651.CrossRefGoogle ScholarPubMed
15.Fujii, Y, Shiga, Y. Flurbiprofen axetil preceded by venous occlusion in the prevention of pain on propofol injection in the hand: a prospective, randomized, double-blind, vehicle-controlled, dose-finding study in Japanese adult surgical patients. Clin Ther 2005; 27: 588–593.CrossRefGoogle ScholarPubMed
16.Fujii, Y, Uemura, A. Effect of metoclopramide on pain on injection of propofol. Anaesth Intensive Care 2004; 32: 653–656.Google Scholar
17.Agarwal, A, Raza, M, Dhiraaj, S, Pandey, R, Gupta, D, Pandey, C. Pain during injection of propofol: the effect of prior administration of butorphanol. Anesth Analg 2004; 99: 117–119.Google Scholar
18.Agarwal, A, Dhiraj, S, Raza, M et al. . Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified. Can J Anesth 2004; 51: 130–133.CrossRefGoogle Scholar
19.Memis, D, Turan, A, Karamanlioglu, B, Sut, N, Pamukcu, Z. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg 2002; 95: 606–608.Google Scholar
20.Morgan, GE, Mikhail, MS, Murray, MJ. Anaphylactic reactions. In: Larson, CP, ed. Clinical Anesthesiology. Los Angeles, USA: Appleton & Lange, 2002: 904–906.Google Scholar
21.Lin, TF, Yeh, YC, Yen, YH, Wang, YP, Lin, CJ, Sun, WZ. Antiemetic and analgesic-sparing effects of diphenhydramine added to morphine intravenous patient-controlled analgesia. Br J Anaesth 2005; 94: 835–839.Google Scholar
22.Smith, JR. Diphenhydramine HCI used as local anesthetic for tooth removal. J Oral Surg 1961; 9: 418–419.Google Scholar
23.JrPollack, CV, Swindle, GM. Use of diphenhydramine for local anesthesia in ‘caine’-sensitive patients. J Emerg Med 1989; 7: 611–614.Google Scholar
24.Yorukoglu, D, Aydos, A, Usta, B, Okten, F. Comparison of alfentanil, ketamine, ketorolac and diphenhydramine for prevention of propofol induced injection pain. Anestezi Dergisi 2000; 8: 30–32.Google Scholar
25.Bass, KD. Tissue response to diphenhydramine hydrochloride. J Oral Surg 1970; 28: 335–345.Google Scholar
26.Kim, YS, Shin, YK, Lee, C, Song, J. Block of sodium currents in rat dorsal root ganglion neurons by diphenhydramine. Brain Res 2000; 881: 190–198.CrossRefGoogle ScholarPubMed
27.Kuo, CC, Huang, RC, Lou, BS. Inhibition of Na(+) current by diphenhydramine and other diphenyl compounds: molecular determinants of selective binding to the inactivated channels. Mol Pharmacol 2000; 57: 135–143.Google Scholar
28.Green, SM, Rothrock, SG, Gorchynski, J. Validation of diphenhydramine as a dermal local anesthetic. Ann Emerg Med 1994; 23: 1284–1289.CrossRefGoogle ScholarPubMed
29.Xia, Y, Chen, E, Tibbits, DL, Reilley, TE, McSweeney, TD. Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection. J Clin Anesth 2002; 14: 339–343.CrossRefGoogle ScholarPubMed
30.Dire, DJ, Hogan, DE. Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Ann Emerg Med 1993; 22: 1419–1422.CrossRefGoogle ScholarPubMed
31.Reisli, R, Celik, J, Tuncer, S et al. . The effect of adding diphenhydramine hydrochloride to lidocaine in intravenous regional anesthesia. Pain Clin 2003; 15: 441–446.Google Scholar
[32]Granana, N, Ferrea, M, Scorticati, MC et al. . Beneficial effects of diphenhydramine in dystonia. Medicina–Buenos Aire 1999; 59: 38–42.Google Scholar
33.Etzel, JV. Diphenhydramine-induced acute dystonia. Pharmacotherapy 1994; 14: 492–496.Google Scholar
34.Brait, KA, Zagerman, AJ. Dyskinesias after antihistamine use. N Engl J Med 1977; 296: 111.Google Scholar
35.Jones, B, Lal, S. Tardive dyskinesia uncovered after ingestion of Sominex, an over-the-counter drug. Can J Psychiatry 1985; 30: 370–371.CrossRefGoogle ScholarPubMed
36.Roila, F, Donati, D, Basurto, C, Del Favero, A. Diphenhydramine and acute dystonia. Ann Intern Med 1989; 111: 92–93.CrossRefGoogle ScholarPubMed