Prevention of pain on injection of propofol: systematic review and meta-analysis

Jalota, Leena; Kalira, V.; George, Elizabeth; Shi, Ying; Hornuß, Cyrill; Radke, Oliver C.; Pace, Nathan L.; Apfel, C. C.

doi:10.1136/bmj.d1110

Cited by 269 publications

(259 citation statements)

References 239 publications

(97 reference statements)

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“…The addition of lidocaine to the anaesthetic can reduce this incidence by 70−80% [13,14]. In our study, 26% of PROP patients reported pain at the injection site, despite administration of 30 mg of lidocaine (i.e., a dose higher than 0.2 mg kg -1 ).…”

Section: Discussionmentioning

confidence: 57%

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

Danielak-Nowak¹,

Musioł²,

Arct-Danielak³

et al. 2016

Anaesthesiol Intensive Ther

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Background: This study compared two types of sedation in pregnant women receiving subarachnoid anaesthesia for elective Caesarean section. Methods: This prospective randomised study included 56 women. Patients were sedated with propofol (PROP group, n = 27) or midazolam (MID group, n = 29) via intravenous infusion after extraction of the foetus. The following parameters were assessed at five-minute intervals: degree of sedation, heart rate, arterial pressure, ECG recording and arterial haemoglobin oxygen saturation. Moreover, we recorded drug doses, changes in infusion rates to ensure a desirable degree of sedation and adverse side effects. The maternal recall of delivery and satisfaction with sedation were also evaluated. Results: The incidence of increased sedative infusion rates was higher in the PROP group (59.3% vs. 37.9%). In contrast, decreased infusion rates were observed in the MID group (41.4% vs. 29.6%). After the initial dose, a desirable level of sedation was easier to obtain in the PROP group (77.7% vs. 55.1%), whereas excessive sedation was noted more frequently in the MID group (34.5% vs. 11.5%). The deepest degree of sedation was found in 2 PROP patients and 1 MID patient. In the PROP group, excessive sedation was rapidly alleviated by reducing the infusion rate. In the MID group, excessive sedation was observed throughout the examination, despite reduced infusion rates. No significant intergroup differences were found for desired sedation levels. The mean heart rate and arterial pressure were lower in the PROP group. In the MID group, only 5% of patients developed an elevated systolic RR. No ECG alterations were observed in any patient. A haemoglobin oxygen saturation level below 92% was found in 1 patient from each group. Logorrhoea was characteristic in the PROP group (44.4%). The incidence of nausea and vomiting were higher in the MID group. Other side effects (e.g., headache, backache, erythema and chills) were observed in a subset of patients from both groups. In the MID group, birth recall was significantly lower (82.8% vs. 96.3%). Full satisfaction with sedation was declared by 89.6% of MID patients and 92.6% of PROP patients. Conclusions: Midazolam and propofol induce effective and safe sedation in patients receiving subarachnoid anaesthesia for Caesarean section. Propofol appears to be more useful for Caesarean section sedation when compared with midazolam because of its shorter action, antiemetic effects and better maternal recall of foetal delivery.

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Section: Discussionmentioning

confidence: 57%

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

Danielak-Nowak¹,

Musioł²,

Arct-Danielak³

et al. 2016

Anaesthesiol Intensive Ther

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“…1 However, propofol causes a high incidence of pain on injection, approximately 60% according to a recent review, with some patients recalling the induction of anesthesia as the most painful part of the perioperative period. 2 Various methods of reducing vascular pain caused by propofol have long been the subject of investigation. Some reports have stated that a mixed injection with lidocaine is effective.…”

mentioning

confidence: 99%

Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration

Sato

Inoue

Hanamoto

et al. 2016

Anesthesia Progress

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Intravenous sedation with propofol is often administered to anxious patients in dental practice. Pain on injection of propofol is a common adverse effect. This study aimed to determine the age-adjusted doses of midazolam required to erase memory of vascular pain of propofol administration and assess whether the Ramsay Sedation Scale (RSS) after the pretreatment of midazolam was useful to predict amnesia of the vascular pain of propofol administration. A total of 246 patients with dental phobia requiring dental treatment under intravenous sedation were included. Patients were classified according to their age: 30s, 40s, 50s, and 60s. Three minutes after administration of a predetermined dose of midazolam, propofol was infused continuously. After completion of the dental procedure, patients were interviewed about the memory of any pain or discomfort in the injection site or forearm. The dosage of midazolam was determined using the Dixon up-down method. The first patient was administered 0.03 mg/kg, and if memory of vascular pain remained, the dosage was increased by 0.01 mg/kg for the next patient, and then if the memory was erased, the dosage was decreased by 0.01 mg/kg. The effective dosage of midazolam in 95% of each age group for erasing the memory of propofol vascular pain (ED 95 ) was determined using logistic analysis. The accuracy of RSS to predict the amnesia of injection pain was assessed by receiver operating characteristic (ROC) analysis. The ED 95 of midazolam to erase the memory of propofol vascular pain was 0.061 mg/kg in patients in their 30s, 0.049 mg/kg in patients in their 40s, 0.033 mg/kg in patients in their 50s, and 0.033 mg/kg in patients in their 60s. The area under the ROC curve was 0.31. The ED 95 of midazolam required to erase the memory of propofol vascular pain demonstrated a downward trend with age. On the other hand, it was impossible to predict the amnesia of propofol vascular pain using the RSS.

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“…9 Among the various methods proposed to decrease injection pain, lidocaine pretreatment with venous occlusion is one of the most effective. 10,11 Pretreatment with 40 mg or 0.5 mg/kg lidocaine with venous occlusion of the upper limb is recommended for alleviating injection pain associated with lipid emulsion propofol administration. 10,12 Using this strategy, the overall incidence of pain on lipid emulsion propofol injection has been reported to range from 8% to 42%, while the incidence of moderate to severe pain ranges from 2% to 16%.…”

Section: Discussionmentioning

confidence: 99%

Intravenous lidocaine pretreatment with venous occlusion for reducing microemulsion propofol induced pain: Comparison of three doses of lidocaine

et al. 2014

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Objective: Pretreatment with intravenous 40 mg or 0.5 mg/kg lidocaine with venous occlusion is recommended to prevent pain following injection of lipid emulsion propofol. This approach is not sufficient to prevent pain from the injection of microemulsion propofol. The present study investigated whether a higher dose of lidocaine pretreatment with venous occlusion would be more effective for reducing pain following injection of microemulsion propofol compared with 40 mg lidocaine. Methods: Patients undergoing elective surgery were randomly assigned to one of three groups: pretreatment with 40 mg (group L40), 60 mg (group L60) or 80 mg (group L80) lidocaine intravenously with venous occlusion, followed by injection with microemulsion propofol 1 min later. Pain was assessed on a four-point scale (severe, moderate, mild, none) based on physical responses to the injection. Results: A total of 68 patients were included in the final analysis. Pain severity and incidence were significantly lower in patients in group L60 and L80 compared with patients in group L40. There were no statistically significant differences in pain incidence or severity between group L60 and group L80. Conclusions: Pretreatment with 60 mg lidocaine intravenously with venous occlusion may be the most effective minimum dose for reducing injection pain following microemulsion propofol administration for induction of anaesthesia.

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Prevention of pain on injection of propofol: systematic review and meta-analysis

Cited by 269 publications

References 239 publications

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section

Effective Dosage of Midazolam to Erase the Memory of Vascular Pain During Propofol Administration

Intravenous lidocaine pretreatment with venous occlusion for reducing microemulsion propofol induced pain: Comparison of three doses of lidocaine

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