Pain on injection of propofol: the effect of injectate temperature

Abstract

SummaryA double-blind, randomised clinical study was undertaken to compare the efSect of temperature on the incidence and severity of the pain experienced on injection of propofol. The number of patients who experienced pain and the severity of the pain were reduced signijicantly when propofol was administered at a temperature of 4°C. The eficacy of propofol as an induction agent appeared to remain unaltered. Key wordsAnaesthetics, intravenous; propofol. Complications; pain.It is well recognised that propofol may cause pain or discomfort on injection when administered intravenously, especially into a vein on the dorsum of the hand. Studies have shown that the incidence may be as high as 45%.' Premedication has little influence on the incidence of pain but may reduce its severity.2 Other important factors are known to be the site and speed of injection3-' and the use of analgesics and local anaesthetics in combination with p r o p o f~l .~-~ This study was designed to assess whether the temperature of propofol affects the incidence or severity of pain on injection. Patients and methodsThe study was performed on 71 adult patients of ASA class 1 and weight 50-85 kg who presented for minor, elective surgery. Informed consent was obtained. All patients received lorazepam 0.5 mg/lO kg to a maximum of 4 mg, 90 minutes before surgery. A 22-gauge cannula was inserted into the largest apparent vein in the dorsum of the hand. The patients were then allocated randomly to one of two groups.General anaesthesia was induced with intravenous propofol 2.5 mg/kg. Patients in group 1 received propofol that had been taken directly from the refrigerator (4-5°C). Those in group 2 received propofol maintained at room temperature (20-23°C). The speed of injection was controlled carefully. One quarter of the total calculated dose was given over the first 5 seconds; after this period, the injection was stopped for 5 seconds to allow assessment of discomfort by the method outlined below. An initial pain score was obtained. Induction was then continued and the second quarter of the total induction dose was administered over a further 5-second period. The patient was questioned again and a second pain score obtained. Finally, the remainder of the induction dose was administered.The level of pain was assessed by a second, independent anaesthetist who was unaware of the group to which the patient had been allocated. The pain score was obtained by asking the patient a standard question about the comfort of the injection and the verbal response, together with behavioural signs such as facial grimacing, arm withdrawal or tears. A score of 0 to 3, which corresponded to no pain, mild, moderate and severe pain, respectively, was recorded ( Table 1). ResultsThe second pain score was higher in all cases and this score was used for later analysis. The results are shown in Table 2. The overall incidence of pain in group 2 was 46% compared with 23% in group 1 (p < 0.05). In addition, less patients in group 1 experienced severe pain (3% versus 21 Yo; p <...

Conditions for laryngeal mask insertionA comparison of propofol versus sevoflurane with or without alfentanil

“…However, propofol has its own side-effects such as pain on injection [8,9] and greater respiratory depression [10]. Sevoflurane is suitable for quick inhalational induction technique even in high concentrations because of its low blood gas solubility (0.69) [11] and minimal respiratory irritant effect [12].…”

Placebo-controlled comparison of using lidocaine or ketamine to reduce the pain during injection of propofol containing a mixture of medium-chain triglyceride/long-chain triglyceride

“…The intensity of pain has increased when propofol injected slowly, especially with a rate of 1 mL/sec. Temperature of injection solution and non-steroidal anti-inflammatory drugs can also reduce injection pain [10][11][12][13][14][15]According to knowledge in the pertinent literature, we determined a standart setup during propofol MCT/LCT injection: dorsum of the hand as injection site, 20G venous catheter as vascular access, room temperatue as the temperatuer of injection solution, and 1 mL per second as injection rate.…”

Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain.

“…[2,4,[14][15][16][17] Hovewer, even in patients who received most popular lidocaine treatment, the incidence of pain has been reported as frequent as 32%-48%. [15] Propofol is an excellent anesthetic that belongs to the group of phenols, which can irritate the skin, mucous membrane and venous intima.…”

“…[4] 0=no pain, 1=mild pain (pain reported in response to questioning without any behavioural sign), 2=moderate pain (pain reported in response to questionning and accompanied by a behavioural sign or pain reported spontaneously without questionning) and 3= severe pain (strong vocal response or response accompanied by facial grimacing, arm withdrawal or tears). [4] After the remainning dose of propofol was injected, fentanyl 1 mcg/kg, vecuronium 0.1 mg/kg was administered to fascilitate endotracheal intubation. Two minutes after vecuronium injection, trachea was intubated and anesthesia was maintained with isoflurane 1-2 vol % and N 2 O 50% in O 2 .…”

“…These include the addition of lidocaine, cooling or warming the drug, diluting the propofol solution, injection of propofol into a large vein, previous injection of ondansetron, granisetron, metoclopromide, magnesium, thiopental with or without tourniquet. [1][2][3][4][5][6][7] Esmolol is an ultra short acting, cardioselective beta-1 adrenergic receptor antagonist. [8] It is effective in preventing adrenergic responses to several perioperative stimuli, including laryngoscopy, endotracheal intubation with tracheal intubation, intraoperative events and tracheal extubation.…”