Injection pain of propofol in children: A comparison of two formulations without added lidocaine

Abstract

Background:Propofol emulsion in medium and long-chain triglycerides (MCT/LCT) has been reported to cause less injection pain than other propofol solutions in adult studies. The aim of this study was to compare the injection pain of two different propofol emulsions using two different pain scales on the pediatric population.Materials and Methods:100 children scheduled for general anesthesia were divided into two groups. Patients were randomly assigned to receive propofol LCT or propofol MCT/LCT. Assessment and evaluation of the Ontario Children's Hospital Pain Scale (mCHEOPS) and the Wong-Baker Faces Scale (WBFS) were performed at the start of the injection until the patients lose consciousness.Results:There were no significant differences between groups in terms of demographic data. According to the mCHEOPS scale, the pain incidence of propofol LCT was 5%, whereas for propofol MCT/LCT it was 15% (P < 0.05). According to the WBFS Pain Scale, the pain incidence of propofol LCT was 17%, whereas for propofol MCT/LCT it was 21% (P > 0.05).Conclusions:Propofol MCT/LCT does not decrease injection pain; contrary to the general assumption, it causes more pain than propofol LCT in children.

Injection Pain of Propofol in Children With Medium Plus Long Chain Triglycerides and Long Chain Propofol Mixed With Lignocaine

“…Beyaz et.al. Reported in a study on 120 children and found that propofol MCT/LCT without lidocaine caused more injection pain than propofol LCT without lidocaine 6 .…”

“…During a propofol injection, pain due to the longchain triglyceride (LCT) emulsion is experienced by 70% of adults and up to 85% of children. Despite various strategies to reduce propofol injection pain, this still poses a clinical problem in adults and children, and the incidence reported to be 30-90% 6 . A meta-analysis showed that lidocaine is most effective in preventing pain when given before propofol and by applying a tourniquet for up to 120 s after its administration vii .…”

A prospective observational study of injection pain in children with medium plus long chain triglyceride and long chain triglyceride propofol premixed with lignocaine

“…So far, of the six paediatric studies[ 2 3 4 5 6 12 ] conducted to compare injection pain by MCT-LCT and LCT propofol, only one study included children ranging from 0 to 7 years of age. [ 6 ] Thus, the evaluation of injection pain in children <2 years age is not very evident.…”

“…[ 6 ] Thus, the evaluation of injection pain in children <2 years age is not very evident. [ 2 3 4 5 12 ] The large sample size ( n = 170) and the inclusion of younger age group (6 months to 8 year) helped making our results easy to generalise for paediatric anaesthesia practice. To avoid other factors, such as site and size of IV cannula, which could contribute to injection pain, we used 24G cannula for all children secured over the dorsum of the hand.…”

“…However, results in paediatric population remain inconclusive. Major limitations with previous studies are inclusion of only older children,[ 2 3 ] omission of lignocaine[ 4 ] or addition of lignocaine in only LCT group. [ 5 ]…”