Does the newer preparation of propofol, an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine?

Varghese, Elsa; Krishna, Handattu Mahabaleswara; Nittala, Anuradha

doi:10.1111/j.1460-9592.2010.03272.x

Cited by 16 publications

(15 citation statements)

References 21 publications

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“…Varghese et. al ., on the other hand, found no difference in the incidence or severity of injection pain when lidocaine is added to both MCT/LCT propofol and LCT propofol [160]. A systematic review and meta-analysis recommends that the use of a small dose of opioids before induction of anesthesia and to use an antecubital vein instead of a hand vein for the propofol lidocaine admixture administration is a simple and effective way to avoid pain.…”

Section: ) Adverse Effectsmentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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Propofol is an intravenous agent used commonly for induction and maintenance of anesthesia, procedural and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially gamma-aminobutyric acid A receptor. Approved for use in the United States by the Federal Drugs and Administration (FDA) in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not “little adults”, in this review, we emphasize the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exist despite the FDA mandating addition of antimicrobial preservative, calling for manufacturers’ directions to discard open vials after six hours. While propofol has advantages over inhalation anesthesia like less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol induced neurotoxicity to the infant brain; however, current concerns of neuroapoptosis in developing brains induced by propofol persist and continue to be a focus of research.

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Section: ) Adverse Effectsmentioning

confidence: 99%

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

2015

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“…[16,17] Propofol-LCT/MCT was specially proposed to decrease injection pain. Varghese et al [18] reported that when added with lidocaine, both propofol-LCT/MCT and propofol-LCT had similar incidence of injection pain. By a systemic review and meta-analysis in 2011, pretreatment with a small dose of opioids halved the incidence of pain after propofol injection, which can generally be recommended.…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of the effect of remifentanil and 2 different doses of esmolol on pain during propofol injection

et al. 2017

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Background: Propofol is associated with pain during injection, which is stressful to patients. The present study was designed to investigate the analgesic effect of pretreatment with remifentanil and esmolol in minimizing propofol injection pain, compared with placebo.Methods: In a randomized, double-blind, prospective trial, 120 patients, scheduled for elective dental surgery under general anesthesia, were randomized to 1 of the 4 treatment arms (n = 30 each) receiving normal saline, remifentanil 0.35 mg/kg, esmolol 0.5 mg/kg, and 1 mg/kg before administration of propofol. During injection of 1% propofol 0.5 mg/kg, pain was evaluated by a 4-point score (0 = none, 1 = mild, 2 = moderate, 3 = severe). Any adverse effects such as hypotension and bradycardia were recorded during the perioperative periods.Results: In all, 120 patients completed this study. There were no significant differences in terms of demographic data. The incidence of pain on injection of propofol was 11 (36.7%) with remifentanil 0.35 mg/kg, 12 (40%) with esmolol 0.5 mg/kg, and 11 (36.7%) with esmolol 1 mg/kg, compared with 25 (83.3%) with normal saline (respectively, P < 0.05). There were no significant differences in the incidence of pain between groups with remifentanil 0.35 mg/kg, and esmolol 0.5 mg/kg and 1 mg/kg. There were no emergence reactions such as hypotension and bradycardia in all groups.Conclusions: Pretreatment with esmolol 0.5 mg/kg and 1 mg/kg and remifentanil 0.35 mg/kg equally decreased pain during propofol injection.Abbreviations: LCT = long-chain triglyceride, MCT = medium-chain triglyceride, NMDA = N-methyl-d-aspartate.

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“…[8,9,17] In the previous study, when premixed with lignocaine, there was no difference in the incidence of pain between propofol LCT and propofol LCT/MCT. [17] …”

Section: Discussionmentioning

confidence: 99%

Comparative study between 2 different doses of pregabalin and lidocaine on pain following propofol injection

Choi

Kim²,

Jeon³

2016

Medicine

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Background:Propofol, an intravenous anesthetic, often causes pain on injection, which can be very distressful to patients. We investigated the analgesic effect of pregabalin on pain following propofol injection, compared with lidocaine.Methods:In a randomized, double-blind, prospective trial, 120 patients were randomized into 3 groups of 40 each; who received oral placebo and intravenous lidocaine 40 mg with venous occlusion for 1 minute (group L, n = 40), oral pregabalin 75 mg and intravenous normal saline with venous occlusion for 1 minute (group LP, n = 40), and oral pregabalin 150 mg and intravenous normal saline with venous occlusion for 1 minute (group HP, n = 40) as pretreatment, followed by administration of 1% propofol 0.5 mg/kg. Pain intensity was measured on a 4-point scale (0 = no, 1 = mild, 2 = moderate, and 3 = severe pain). Any side effects associated with pretreatment substances were recorded during the first 24 hours after surgery.Results:A total of 120 patients completed this trial. Demographic data were similar between groups. The incidence of pain following propofol injection was significantly reduced in group HP (50%) and group L (55%) compared with group LP (92.5%) (P < 0.05, respectively). The incidences of moderate pain in group HP (12.5%) and group L (15%) were significantly decreased compared with group LP (37.5%; both, P < 0.05). There were no significant differences in the incidence of side effects such as headache and dizziness between groups.Conclusion:Pretreatment with oral pregabalin 150 mg and intravenous lidocaine 40 mg with venous occlusion equally reduced pain from propofol injection.

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Does the newer preparation of propofol, an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine?

Abstract: Propofol MCT/LCT and propofol LCT premixed with lignocaine are both associated with pain on injection in children; the incidence and intensity of the injection pain are similar.

Cited by 16 publications

References 21 publications

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

Propofol: A Review of its Role in Pediatric Anesthesia and Sedation

Comparative evaluation of the effect of remifentanil and 2 different doses of esmolol on pain during propofol injection

Comparative study between 2 different doses of pregabalin and lidocaine on pain following propofol injection

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