Pain on propofol injection: Causes and remedies

Abstract

Pain on propofol injection (POPI) is a minor problem that all anesthetists face every day. Introduction of several new formulations and hundreds of clinical trials have failed to find its remedy with just one intervention in all patients. This article highlights the causes of POPI and interventions that are used to eliminate this pain in current practice. Relevant articles from Medline and Embase databases were searched and included in this descriptive review with the following conclusions: (1) POPI is due to irritation of venous adventitia leading to release of mediators such as kininogen from kinin cascade. (2) When two or more drugs or measures are used, the incidence of POPI decreases considerably. Hence, the approach to eliminating POPI should be multimodal. (3) Any regimen that includes a drug having local anesthetic effect combined with central sedative/analgesic and rapid injection into a large vein should definitely reduce the risk of POPI to negligible levels.

A Prospective Study on the Predictability of Propofol Injection Pain

“…POPI is a clinical problem that must be managed by anesthesiologists. Literature reports that POPI can be seen in up to 90% of patients, especially when the injection is made to small diameter veins such as those on the dorsum of the hand [1,15]. Many agents, such as lidocaine, ketamine, ephedrine, and magnesium, have been used for the prevention of POPI [2,[16][17].…”

“…Propofol is the most frequently used hypnotic agent in anesthesia induction and total intravenous anesthesia (TIVA) [1]. Pain on propofol injection (POPI) is a commonly encountered clinical problem [1][2][3].…”

“…Propofol is the most frequently used hypnotic agent in anesthesia induction and total intravenous anesthesia (TIVA) [1]. Pain on propofol injection (POPI) is a commonly encountered clinical problem [1][2][3]. Many medications, such as lidocaine, fentanyl, and ephedrine, have been evaluated for the management of POPI [4][5][6][7].…”

“…The cause of pain during injection of propofol is theorized to be due to endothelial damage, osmolality difference, nonphysiological pH, and stimulation of venous nociceptive receptors and free nerve ends although it is generally accepted to be multifactorial [2][3][4][5][6][7][8]. The incidence of POPI is reported to be between 28% and 90% and is considered to leave a bad memory of general anesthesia in patients [1]. Despite many studies on the management of POPI, data are scarce with regards to any correlation with patient demographics and the ability to predict POPI [9].…”

A randomized control study on anesthetic effects of flurbiprofen axetil combined with propofol on patients with liver cancer receiving microwave ablation

“…Meanwhile, the analgesic effect of propofol is weak. 10 Therefore, propofol is often combined with other anesthetic and analgesic drugs in clinical practice. 11…”