Aspirin in the prevention of painful intravenous injection of disoprofol (ICI 35,868) and diazepam (Valium)

Bahar, M.; McAteer, E.; Dundee, J. W.; Briggs, L.P.

doi:10.1111/j.1365-2044.1982.tb01821.x

Cited by 33 publications

(25 citation statements)

References 6 publications

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“…With the Cremophor formulation, reports of the effects of premedicant drugs have been ~onflicting,~.~ but pretreatment with intravenous aspirin and fentanyl proved effective in one series. 6 Intravenous lignocaine has been used with varied success to prevent or reduce pain with methohexitone and etomidate induction. 13-l 6 In this study, the use of intravenous lignocaine reduced the incidence of pain from 37.5% to 17.5%.…”

Section: Discussionmentioning

confidence: 99%

Assessment and modification of pain on induction with propofol (Diprivan)

1985

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Forum 1117cover these points at the induction of new house officers. In addition, the notes on pre-operative assessment and preparation which arecurrently issued to staff on induction will be amplified to cover common complications. As it may be unreasonable to expect staff to be completely conversant with all anaesthetic drugs, this problem will be obviated by re-designing the anaesthetic record form to categorise the drugs used. Finally, one cannot overemphasise the role of the anaesthetist in continuing the education of the junior staff with whom he comes into contact. References Key words Anaestherics, iniravenous: propofolComplicar ions; pain .The intravenous anaesthetic 2, 6 di-isopropylphenol was originally formulated in Cremophor EL. Initial clinical experience established its efficacy,' -3 but concern arose over the disturbingly high incidence of pain on injection and possible anaphylactoid res p o n s e~.~-' For these reasons. a new emulsified formulation, propofol. has been developed: The aims of this study were to determine the incidence of pain at injection site using the new formulation. and to assess the effect of pretreatment with intravenous lignocaine. MethodThe study was approved by the Hospital Ethical Committee, and written, informed consent was obtained from each patient. One hundred and sixty patients aged between 16 and 65 years, of ASA grade I o r 2 and undergoing minor, elective surgery were studied. Those with a history of adverse reactions to anaesthesia were excluded, a s were pregnant patients unless termination of pregnancy was the planned procedure. and those who were more than 10% above expected body weight.Premedication was either omitted or consisted of atropine 0.6 mg given intramuscularly, approximately one hour before induction. Upon arrival in the anaesthetic room, patients were randomly allocated to one of four groups. All injections were made over 20 seconds, via a 21-gauge needle as follows: Group A, dorsum of 1118 Forum hand, propofol 2.5 mg/kg: Group B, forearm/antecubital fossa, propofo12.5 mg/kg; Group C. dorsum of hand, lignocaine 10 mg followed by propofo12.5 mg/kg; Group D, dorsum of hand, thiopentone 4.5 mg/kg. For 2 minutes after induction, oxygen 3 litresiminute and nitrous oxide 6 litreslminute were administered via a Magill system. Thereafter. additional agents were used as required.Several observations were made. Any spontaneous comments about feelings at the site of injection and responses to the question 'Is that comfortable? were noted. The inducrion rime was measured in seconds, from beginning of injection to loss of verbal contact and eyelash reflex. Arterial blood pressure and heart rate were measured noninvasively at 0, I, 2 and 5 minutes postinduction. The incidence and duration of apnoea were recorded and ventilation was assisted if apnoea exceeded 2 minutes. Note was taken of any excitatory effects and evidence of anaphylactoid reactions. The injection site was inspected immediately postoperatively and at 24 and 48 hours, when possible, for eviden...

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Section: Discussionmentioning

confidence: 99%

Assessment and modification of pain on induction with propofol (Diprivan)

1985

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“…However, about half of patients still experience moderate to severe pain on injection. [1][2][3] Thus, several methods have been devised to prevent this pain, for example injection into a larger vein, use of various drugs (aspirin, fentanyl, alfentanil, metoclopramide, nitroglycerin, prilocaine, pethidine), [4][5][6][7][8][9] and co-administration with either lidocaine or nafamostat mesilate (a kallikrein inhibitor), 2,3,10,11 of which the most effective and common are use of a larger vein and mixing with lidocaine. Regarding one of the mechanisms of injection pain, our recent studies demonstrated generation of the bradykinin caused by propofol and its inhibitory effect of lidocaine and nafamostat mesilate, so that these two drugs are considered to decrease the pain by reducing the plasma bradykinin levels.…”

Section: Résultatsmentioning

confidence: 99%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared.M Me et th ho od ds s: : Two hundred adult patients randomly allocated to two groups were given 1.5 mg·kg -1 iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg·min -1 in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol.R Re es su ul lt ts s: : There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results.C Co on nc cl lu us si io on ns s: : LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase. Objectif : On a pensé qu'une émulsion de propofol avec une chaîne mi-longue de triglycéride (CLT/CMT) cause moins de douleur à l'injection qu'une émulsion à chaîne longue (CLT) parce que la concentration de propofol diminue pendant la phase aqueuse. Aussi, le propofol avec CLT génère de la bradykinine, causant de la douleur à l'injection, et active le complément, mais ces effets n'ont pas été étudiés avec le propofol CLT/CMT. Pour définir le mécanisme qui réduit la douleur avec le propofol CLT/CMT, nous avons comparé la douleur à l'injection, la génération de bradykinine et l'activation du complément avec l'usage des deux produits de propofol. Méthode : Deux cents patients adultes ont été répartis au hasard en deux groupes et ont reçu 1,5 mg·kg -1 iv de propofol CLT ou CLT/CMT

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“…Nonsteroidal antiinflammatory drugs (NSAIDs), therefore, might reduce the pain of propofol injection by reducing prostaglandin synthesis and/or inhibiting the kinin cascade [7]. In addition to these well-known peripheral effects of NSAIDs, in clinical settings they exert an antinociceptive effect via the central nervous system [8,9], including spinal effects [10].Although administration of intravenous aspirin was reported to be effective for pain induced by propofol injection [11], pretreatment with intravenous ketorolac did not reduce pain during injection [12,13]. However, it may be difficult to assess the effects of NSAIDs on pain from propofol injection using ketorolac, because most NSAIDs, including ketorolac, have an irritant effect [14].…”

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confidence: 99%