Dexmedetomidine pretreatment alleviates propofol injection pain

Background and Aims:Propofol is widely used for induction of anaesthesia, although the pain during its injection remains a concern for all anaesthesiologists. A number of techniques have been adopted to minimise propofol-induced pain. Various 5-hydroxytryptamine-3 antagonists have shown to reduce propofol-induced pain. Hence, this placebo-controlled study was conducted to compare the efficacy of ondansetron, ramosetron and lignocaine in terms of attenuation of propofol-induced pain during induction of anaesthesia.Methods:Hundred and fifty adult patients, aged 18–60 years, posted for various elective surgical procedures under general anaesthesia were randomly assigned to three groups of 50 each. Group R received 0.3 mg of ramosetron, Group L received 0.5 mg/kg of 2% lignocaine and Group O received 4 mg of ondansetron. After intravenous (IV) pre-treatment of study drug, manual occlusion of venous drainage was done at mid-arm with the help of an assistant for 1 min. This was followed by administration of propofol (1%) after release of venous occlusion. Pain was assessed with a four-point scale. Unpaired Student's t-test and Chi-square test/Fisher's exact test were used to analyse results.Results:The overall incidence and intensity of pain were significantly less in Groups L and R compared to Group O (P ≤ 0.001). The incidence of mild to moderate pain in Groups O, R and L was 56%, 26% and 20%, respectively. The incidence of score ‘0’ (no pain) was significantly higher in Group L (76%) and Group R (72%) than Group O (34%) (P < 0.001).Conclusion:Pre-treatment with IV ramosetron 0.3 mg is equally effective as 0.5 mg/kg of 2% lignocaine in preventing propofol-induced pain and both were better than ondansetron.

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“…[ 5 6 ] Dexmedetomidine a newer α adrenergic agonist has been used to alleviate propofol injection pain. [ 7 ]…”

Section: Introductionmentioning

confidence: 99%

A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron

et al. 2016

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“…Many studies which aimed to reduce propofol injection pain have been performed [9], and the preventive effects of dexmedetomidine were reported in some studies [10,11]. Li et al [12] performed a randomized controlled study to examine the attenuation effect of dexmedetomidine pretreatment for propofol injection pain in 137 patients who underwent electroconvulsive therapy.…”

Section: Intraoperative Dexmedetomidine For Intra and Postoperative Pmentioning

confidence: 99%

Dexmedetomidine as an adjuvant during general anesthesia

Obara

2018

J Anesth

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“…Nevertheless, its adverse cardiovascular and hemodynamic effects and swelling at its injection site need to be further studied (14,15). Recent reports have shown that dexmedetomidine (Dex-) is as highly effective in attenuating propofol-induced pain as lidocaine (6,16). On the other hand, Dex-is a highly selective alpha-2 adrenoceptor agonist and exhibits analgesic, sedative, and sympatholytic properties that regulate the incidence and intensity of propofol injection pain.…”

Section: Introductionmentioning

confidence: 99%

Intravenous Dexmedetomidine Administration Prior Anesthesia Induction With Propofol at 4°C Attenuates Propofol Injection Pain: A Double-Blind, Randomized, Placebo-Controlled Trial

Liu³

et al. 2021

Front. Med.

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Background: Propofol injection pain, despite various interventions, still occurs during the anesthesia induction and causes intense discomfort and anxiety in patients. This study aimed to explore the effect of intravenous dexmedetomidine on propofol injection pain prior to anesthesia induction with propofol at 4°C.Methods: A total of 251 patients (American Society of Anesthesiologists I–II) who underwent oral and maxillofacial surgery were randomly assigned to a combination group (n = 63), lidocaine group (n = 62), dexmedetomidine group (n = 63), and placebo-control group (n = 63); they received 0.5 ug/kg dexmedetomidine prior to anesthesia induction with propofol at 4°C, 40 mg lidocaine, 0.5 ug/kg dexmedetomidine prior to anesthesia induction, and normal saline, respectively. Incidence of pain, pain intensity, and reaction to the pain stimulus were evaluated by using verbal categorial scoring (VCS), a numerical rating scale (NRS), and the Surgical Pleth Index (SPI), respectively. In addition, hemodynamic parameters such as heart rate (HR) and mean arterial pressure (MAP) were also measured. The VCS and NRS were evaluated at 5 s after propofol injection. In addition, SPI, HR, and MAP were evaluated at three time points (before anesthesia induction and 5 and 30 s after propofol injection).Results: The incidence of pain in the combination group (51%) was significantly lower than that in the lidocaine group (71%), dexmedetomidine group (67%), or placebo-control group (94%) (p < 0.001). VCS and NRS scores in the combination group were also lower compared with the other three groups (p < 0.001), with no statistically significant differences between the lidocaine group and dexmedetomidine group (p > 0.05). The SPI of the combination group decreased significantly in comparison with the other three groups at 5 s after propofol injection (F = 96.23, p < 0.001) and 30 s after propofol injection (F = 4.46, p = 0.005). Further comparisons between HR and MAP revealed no significant differences across the groups (p > 0.05).Conclusion: Because of the sedative nature of dexmedetomidine and analgesic effect of low temperature, this study showed that intravenous dexmedetomidine prior to anesthesia induction with propofol at 4°C is highly effective in attenuating the incidence and severity of pain during injection compared with lidocaine (40 mg), dexmedetomidine 0.5 ug/kg) and placebo. This approach was not associated with any anesthesia complications.Clinical Trial Registration:ClinicalTrials.gov, identifier: ChiCTR-2000034663

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Dexmedetomidine pretreatment alleviates propofol injection pain

Cited by 24 publications

References 34 publications

A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron

A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron

Dexmedetomidine as an adjuvant during general anesthesia

Intravenous Dexmedetomidine Administration Prior Anesthesia Induction With Propofol at 4°C Attenuates Propofol Injection Pain: A Double-Blind, Randomized, Placebo-Controlled Trial

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