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Reduction of pain on injection of propofol: combination of pretreatment of remifentanil and premixture of lidocaine with propofol

Published online by Cambridge University Press:  01 September 2007

K. Kwak ,
J. Kim ,
S. Park ,
D. Lim ,
S. Kim ,
W. Baek  and
Y. Jeon
K. Kwak
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
J. Kim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
S. Park
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
D. Lim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
S. Kim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
W. Baek
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
Y. Jeon*
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
*
Correspondence to: Younghoon Jeon, Department of Anesthesiology, School of Medicine, Kyungpook National University, 50 Samduck 2ga, Jung gu, Daegu 700-721, South Korea. E-mail: jeon68@knu.ac.kr; Tel: +82 53 420 5871; Fax: +82 53 426 2760
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Summary

Backgrounds and objective

There is a high incidence of pain following intravenous injection of propofol, and many studies have been conducted to find a way of reducing this. The administration of lidocaine and, recently, remifentanil has also been used for this purpose, but it is only partially effective. Thus, the purpose of this study was to investigate the analgesic effect of a combination of pretreatment with remifentanil and premixture of lidocaine with propofol and to compare either treatment alone during propofol injection in dorsal hand-veins.

Methods

In a prospective, randomized, double-blinded trial, we studied 141 adult patients scheduled for elective surgery. The combination of pretreatment of remifentanil (0.35 μg kg−1 min−1) and a premixture of lidocaine with propofol (mixture of propofol 1% and lidocaine 1% in a 10 : 1 ratio) was compared with either treatment alone in the prevention of pain on propofol injection. Pain was assessed on a four-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe) during propofol injection. Patients in Group B received remifentanil (0.35 μg kg−1 min−1) 30 s before the injection of propofol.

Results

The reduction of pain on propofol injection was similar in both the remifentanil pretreatment and lidocaine premixture groups (62.2% vs. 62.2%). Combination therapy was associated with a higher incidence of patients without pain (91.3%) than either treatment alone (P < 0.001). On analysing the injection pain scores, we found a significant reduction of the score in the remifentanil and lidocaine Group C compared with the lidocaine Group A (P < 0.001) and the remifentanil Group B (P < 0.001).

Conclusions

The combination of pretreatment of remifentanil and premixture of lidocaine with propofol was more effective in reducing the incidence of pain on injection of propofol than either treatment alone.

Keywords

ANAESTHETICS INTRAVENOUSPROPOFOLLIDOCAINEADVERSE EFFECTSANALGESICS OPIOID, remifentanil
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 746 - 750
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Smith, I, White, PF, Nathanson, M, Gouldson, R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005–1043.Google ScholarPubMed
2.Helmers, JH, Kraaijenhagen, RJ, van Leeuwen, L, Zuurmond, WW. Reduction of pain on injection caused by propofol. Can J Anaesth 1990; 37: 267–268.CrossRefGoogle ScholarPubMed
3.Liljeroth, E, Grauers, A, Akeson, J. Pain on injection of propofol with or without infusion of carrier fluid. Acta Anaesthesiol Scand 2001; 45: 839–841.CrossRefGoogle ScholarPubMed
4.Klement, W, Arndt, JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991; 67: 281–284.CrossRefGoogle ScholarPubMed
5.Stokes, DN, Robson, N, Hutton, P. Effect of diluting propofol on the incidence of pain on injection and venous sequelae. Br J Anaesth 1989; 62: 202–203.CrossRefGoogle ScholarPubMed
6.Parmar, AK, Koay, CK. Pain on injection of propofol. A comparison of cold propofol with propofol premixed with lignocaine. Anaesthesia 1998; 53: 79–83.CrossRefGoogle ScholarPubMed
7.Picard, P, Tramer, MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–969.Google ScholarPubMed
8.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.CrossRefGoogle ScholarPubMed
9.Scott, RP, Saunders, DA. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492–494.CrossRefGoogle ScholarPubMed
10.Tan, CH, Onsiong, MK. Pain on injection of propofol. Anaesthesia 1998; 53: 468–476.CrossRefGoogle ScholarPubMed
11.Glass, PS, Gan TJ Howell, S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 1999; 89 (Suppl 4): S7–S14.CrossRefGoogle ScholarPubMed
12.Sebel, PS, Hoke, JF, Westmoreland, C et al. . Histamine concentrations and hemodynamic responses after remifentanil. Anesth Analg 1995; 80: 990–993.Google ScholarPubMed
13.Basaranoglu, G, Erden, V, Delatioglu, H, Saitoglu, L. Reduction of pain on injection of propofol using meperidine and remifentanil. Eur J Anaesth 2005; 22: 890–892.CrossRefGoogle ScholarPubMed
14.Roehm, KD, Piper, SN, Maleck, WH, Boldt, J. Prevention of propofol-induced injection pain by remifentanil: a placebo-controlled comparison with lidocaine. Anaesthesia 2003; 58: 165–170.CrossRefGoogle ScholarPubMed
15.Iyilikci, L, Balkan, BK, Gokel, E, Gunerli, A, Ellidokuz, H. The effects of alfentanil or remifentanil pretreatment on propofol injection pain. J Clin Anesth 2004; 16: 499–502.CrossRefGoogle ScholarPubMed
16.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.CrossRefGoogle ScholarPubMed
17.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 ScholarPubMed
18.Briggs, LP, Bahar, M, Beers, HT et al. . Effect of preanaesthetic medication on anaesthesia with ICI 35, 868. Br J Anaesth 1982; 54: 303–306.CrossRefGoogle ScholarPubMed
19.Doenicke, AW, Roizen, MF, Rau, J, Kellermann, W, Babl, J. Reducing pain during propofol injection: the role of the solvent. Anesth Analg 1996; 82: 472–474.Google ScholarPubMed
20.Eriksson, M, Englesson, S, Niklasson, F, Hartvig, P. Effect of lignocaine and pH on propofol-induced pain. Br J Anaesth 1997; 78: 502–506.CrossRefGoogle ScholarPubMed
21.Lilley, EM, Isert, PR, Carasso, ML, Kennedy, RA. The effect of the addition of lignocaine on propofol emulsion stability. Anaesthesia 1996; 51: 815–818.CrossRefGoogle ScholarPubMed
22.Masaki, Y, Tanaka, M, Nishikawa, T. Changes in propofol concentration in a propofol-lidocaine 9 : 1 volume mixture. Anesth Analg 2000; 90: 989–992.CrossRefGoogle Scholar
23.Tham, CS, Khoo, ST. Modulating effects of lidocaine on propofol. Anaesth Intens Care 1995; 23: 154–157.CrossRefGoogle ScholarPubMed
24.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
25.Gajraj, N, Nathanson, M. Preventing pain during injection of propofol: the optimal dose of lidocaine. J Clin Anesth 1996; 8: 575–577.CrossRefGoogle ScholarPubMed
26.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
27.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.CrossRefGoogle ScholarPubMed
28.Fletcher, JE, Seavell, CR, Bowen, DJ. Pretreatment with alfentanil reduces pain caused by propofol. Br J Anaesth 1994; 72: 342–344.CrossRefGoogle ScholarPubMed
29.Pang, WW, Mok, MS, Huang, S, Hwang, MH. The analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: a comparative study. Anesth Analg 1998; 86: 382–386.Google ScholarPubMed