Injektionsschmerzen nach Propofolgabe

Abstract

Injection-induced pain during induction of anaesthesia can result in patient's discomfort. This can prevent the use of propofol-anaesthesia in paediatric patients. Because of the high incidence of pain on injection with propofol numerous interventions have been tested to prevent this pain including the use of different drugs and physical measures as well as the combination of methods. The use of a single intervention is not as effective as the combination of different preventive measures. Thus the additional application of a venous tourniquet improves the pain reducing effect if drugs with peripheral mechanism of action are used for prevention of pain. Injection of lidocaine with a rubber tourniquet before the propofol injection is recommended as best effective method. In any case a propofol-MCT/LCT-Emulsion should be used for propofol-anaesthesia. Additionally a multimodal strategy that is adapted to the daily clinical practice seems to be convenient. That means, for general anaesthesia opioids or ketamine and for sedation a sub-anaesthetic dose of thiopental can be used for effective prevention of pain. If the prevention of nausea and emesis is intended, antiemetics that are appropriate for prevention of injection pain should be given. For paediatric anaesthesia the application of EMLA-cream seems to be suitable, because it alleviates the pain during venous cannulation at the same time. Although a painfree propofol injection is not possible with every prevention strategy there exist a wide range of effective interventions to prevent pain on injection with propofol. This article reviews methods that have been investigated and established to minimise the incidence of pain.

Prevention of propofol injection pain: Comparison between lidocaine and ramosetron

“…[567] It has been demonstrated that ondansetron, a specific 5-hydroxytryptamine (5HT 3 ) receptor antagonist, provided numbness when injected under the skin and is 15 times more potent than lidocaine. [8] It has been further demonstrated that ondansetron successfully relieved pain following propofol injection without any adverse effects in a significant number of patients.…”

Efficacy and safety of ciprofol versus propofol for the induction of anesthesia in adult patients: a multicenter phase 2a clinical trial

“…There is another potential advantage of ciprofol, namely less injection pain on administration compared to propofol. This conjecture is based on the fact that the injection pain produced by propofol is attributable to the absolute drug concentration in the aquatic phase [ 28 , 29 ]. A concentration of ciprofol of 50 mg/20 mL (vs. propofol at 200 mg/20 mL) should dramatically reduce the concentration in the aquatic phase and therefore the degree of injection pain [ 10 ].…”

Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…Häufiger ist die Applikation von Propofol insbesondere in schmalkalibrige, periphere Venen schmerzhaft. Dieser Injektionsschmerz kann durch intravenöse Lokalanästhesie oder durch Injektion eines Lokalanästhetikums bei Bedarf, nach einer kleinen Propofol-Probedosis, weitgehend vermieden werden 494 495 496 497 .…”