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

Abstract

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

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

“…Peripheral nerve fibers sense nociceptive information and transfer it onward. Based on this mechanism, many techniques have been developed to reduce the incidence of PIP, such as changing the temperature and concentration of propofol ( Jeong and Yoon, 2016 ; Lu et al, 2021 ), controlling injection speed, selecting large vein vessels ( Canbay et al, 2008 ; Desousa, 2016 ), transcutaneous electrical acupoint stimulation ( Jin et al, 2022 ), or pre-treatment or mixed use propofol with drugs, such as lidocaine ( Euasobhon et al, 2016 ; Hong et al, 2016 ; Jeong and Yoon, 2016 ; Sun et al, 2016 ; Zirak et al, 2016 ; Xing et al, 2018 ; Tian et al, 2021 ; Wasinwong et al, 2022 ), nonsteroidal anti-inflammatory drugs ( Madan et al, 2016 ; Miniksar, 2022 ), and dexmedetomidine ( Yu et al, 2015 ; Lu et al, 2021 ).…”

“…PIP is considered an unpleasant encounter in anesthesia practice ( Jalota et al, 2011 ). Many techniques have been developed to reduce the incidence of PIP, including changing the temperature and concentration of propofol ( Jeong and Yoon, 2016 ; Lu et al, 2021 ), controlling the injection speed, selecting large vein vessels ( Canbay et al, 2008 ; Desousa, 2016 ), and transcutaneous electrical acupoint stimulation ( Jin et al, 2022 ). The most common techniques are pre-treatment or mixed use of propofol with drugs such as lidocaine ( Euasobhon et al, 2016 ; Hong et al, 2016 ; Jeong and Yoon, 2016 ; Sun et al, 2016 ; Zirak et al, 2016 ; Xing et al, 2018 ; Tian et al, 2021 ; Wasinwong et al, 2022 ), nonsteroidal anti-inflammatory drugs ( Madan et al, 2016 ; Miniksar, 2022 ), dexmedetomidine ( Yu et al, 2015 ; Lu et al, 2021 ), ketamine ( Cheng et al, 2017 ; Akbari et al, 2018 ), nitrous oxide ( Kaabachi et al, 2007 ), opioids ( Kizilcik et al, 2015 ; Lee et al, 2016 ; Singh et al, 2016 ; Lee et al, 2017 ; Wang et al, 2020 ), benzodiazepines ( Guan et al, 2021 ), and magnesium sulfate ( Sun et al, 2016 ).…”

“…Many techniques have been developed to reduce the incidence of PIP, including changing the temperature and concentration of propofol ( Jeong and Yoon, 2016 ; Lu et al, 2021 ), controlling the injection speed, selecting large vein vessels ( Canbay et al, 2008 ; Desousa, 2016 ), and transcutaneous electrical acupoint stimulation ( Jin et al, 2022 ). The most common techniques are pre-treatment or mixed use of propofol with drugs such as lidocaine ( Euasobhon et al, 2016 ; Hong et al, 2016 ; Jeong and Yoon, 2016 ; Sun et al, 2016 ; Zirak et al, 2016 ; Xing et al, 2018 ; Tian et al, 2021 ; Wasinwong et al, 2022 ), nonsteroidal anti-inflammatory drugs ( Madan et al, 2016 ; Miniksar, 2022 ), dexmedetomidine ( Yu et al, 2015 ; Lu et al, 2021 ), ketamine ( Cheng et al, 2017 ; Akbari et al, 2018 ), nitrous oxide ( Kaabachi et al, 2007 ), opioids ( Kizilcik et al, 2015 ; Lee et al, 2016 ; Singh et al, 2016 ; Lee et al, 2017 ; Wang et al, 2020 ), benzodiazepines ( Guan et al, 2021 ), and magnesium sulfate ( Sun et al, 2016 ). All of these techniques or drugs attenuated PIP to varying degrees, but their drawbacks, such as laryngospasm ( Batra et al, 2005 ; Kaabachi et al, 2007 ), emergence agitation ( Kaabachi et al, 2007 ), gastrointestinal ulcer ( Madan et al, 2016 ), pulmonary embolism ( Davies et al, 2002 ), lengthy onset ( Wang et al, 2020 ), and tinnitus or dizziness ( Xing et al, 2018 ), limited their clinical use, and PIP could not be completely abolished.…”