Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-27T12:11:08.945Z Has data issue: false hasContentIssue false
  • English
  • Français

Lidocaine is more efficient than the choice of propofol formulations to reduce incidence of pain on induction

Published online by Cambridge University Press:  01 May 2007

A. Mallick ,
S. C. Elliot ,
K. Krishnan  and
M. Vucevic
A. Mallick*
Affiliation:
Anaesthesia and Intensive Care Unit, Leeds, UK
S. C. Elliot
Affiliation:
Adult General Intensive Care Unit, Leeds, UK
K. Krishnan
Affiliation:
Anaesthesia, Leeds General Infirmary, Leeds, UK
M. Vucevic
Affiliation:
Anaesthesia, Leeds General Infirmary, Leeds, UK
*
Correspondence to: Abhiram Mallick, Anaesthesia and Intensive Care Unit, Leeds General Infirmary, Leeds LS1 3EX, UK. E-mail: abhiram.mallick@leedsth.mhs.uk; Tel: +44 1133926345; Fax: +44 1133928431
Get access

Summary

Background and objective

Propofol is associated with pain on injection. It is common practice to premix lidocaine with propofol prior to injection. Lipuro propofol, a propofol emulsified in medium- and long-chain triglycerides, has been shown to reduce the intensity of injection pain compared to Diprivan®, although a number of studies report no reduction in overall incidence of pain.

Methods

We conducted this randomized double-blind trial to determine the extent of further pain reduction by adding lidocaine to Lipuro propofol. A total of 328 ASA I–III patients were randomized to one of four groups to receive Diprivan propofol (Group DP), Lipuro propofol (Group LP), Diprivan with lidocaine (Group DL) and Lipuro propofol with lidocaine (Group LL). The drug mixture was administered at a constant rate of 400 mL h−1 via a 20-G cannula into a dorsal hand vein. Pain was assessed during induction and upon patient recovery, using a 10-point visual analogue scale.

Results

Both the incidence and severity of pain were found to be significantly lower with addition of lidocaine to Lipuro propofol (P < 0.0002) compared to Lipuro alone, Diprivan with or without the addition of lidocaine.

Conclusion

Lidocaine added to Lipuro propofol makes induction of anaesthesia less painful compared to Lipuro propofol alone or Diprivan with lidocaine.

Keywords

ANAESTHETICSINTRAVENOUSPROPOFOL; formulationADVERSE EFFECTSLIDOCAINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 403 - 407
Copyright
Copyright © European Society of Anaesthesiology 2007

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.)

Footnotes

The abstract of this trial was presented as an oral presentation at the 49th Annual Congress of the Association of Anaesthetists of Great Britain and Ireland, held in 2005 at Manchester, UK.

References

1.Picard, P, Tramer, MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–969.Google ScholarPubMed
2.Doenicke, AW, Roizen, MF, Rau, J et al. . Reducing pain during propofol injection: the role of the solvent. Anesth Analg 1996; 82: 472–474.Google ScholarPubMed
3.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
4.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
5.Larsen, B, Beerhalte, 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(in German).CrossRefGoogle ScholarPubMed
6.Liljeroth, E, Akeson, J. Less local pain on intravenous infusion of a new propofol emulsion. Acta Anaesthesiol Scand 2005; 49: 248–251.CrossRefGoogle ScholarPubMed
7.Sun, NCH, Wong, AYC, Irwin, MG. A comparison of pain on intravenous injection between two preparations of propofol. Anesth Analg 2005; 101: 675–678.CrossRefGoogle ScholarPubMed
8.Ayuso, MA, Luis, M, Sala, X, Fernandez, J, Gomar, C. Incidence of pain upon injection of a new formula of propofol in a fat emulsion of medium and long chain triglycerides. Rev Esp Anestesiol Reanim 2004; 51: 531–536 (in Spanish).Google Scholar
9.Rohm, KD, Piper, SN, Schollhorn, TA, Suttner, SW, Laleck, WH, Boldt, J. Injection pain secondary to propofol-MCT/LCT and propofol-LCT – comparison of prophylaxis with lidocaine. Anasthesiol Intensivmed Notfallmed Schmerzther 2003; 38: 634–637 (in German).Google ScholarPubMed
10.Schaub, E, Kern, C, Landau, R. Pain on injection: a double-blind comparison of propofol with lignocaine pretreatment versus propofol formulated with long- and medium-chain triglycerides. Anesth Analg 2004; 99: 1699–1702.CrossRefGoogle ScholarPubMed
11.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 lignocaine. Anesth Analg 2004; 99: 1076–1079.CrossRefGoogle Scholar
12.Kam, E, Abdul-Latif, MS, McCluskey, A. Comparison of Propofol–Lipuro with lidocaine 10 mg on propofol injection pain. Anaesthesia 2004; 59: 1167–1169.CrossRefGoogle ScholarPubMed
13.Nyman, Y, von Hofsten, K, Georgiadi, A, Eksborg, S, Lönnqvist, PA. Propofol injection pain in children: a prospective randomized double-blind trial of a new propofol formulation versus propofol with added lidocaine. Br J Anaesth 2005; 95: 222–225.CrossRefGoogle ScholarPubMed
14.Bachmann-Mennenga, B, Ohlmer, A, Boedekar, RH, Mann, M, Muhlenbruch, B, Heesen, M. Preventing pain during injection of propofol: effects of a new emulsion with lidocaine addition. Eur J Anaesthesiol 2006; 7: 1–6.Google Scholar
15.Ayuso, MA, Luis, M, Sala, X, Fernandez, J, Gomar, C. Incidence of pain upon injection of a new formula of propofol in a fat emulsion of medium- and long-chain triglycerides. Rev Esp Anestesiol Reanim 2004; 51: 531–536 (in Spanish).Google Scholar
16.Minogue, SC, Sun, DA. Bacteriostatic saline containing benzyl alcohol devreases the pain associated with the injection of propofol. Anesth Analg 2005; 100: 683–686.CrossRefGoogle Scholar