Reducing Pain During Propofol Injection

Doenicke, Α.; Roizen, Michael F.; Rau, Jens; Kellermann, W.; Babl, Juergen

doi:10.1213/00000539-199603000-00007

Cited by 59 publications

(79 citation statements)

References 15 publications

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“…[12][13][14][15] Association between the aqueous phase propofol concentration and injection pain has also been reported in some studies. 23,24 Thus, it is possible that a reduction in either bradykinin generation or the aqueous phase propofol concentration decreases the pain on injection with propofol.…”

Section: Bradykinin Generation and Complement Activationmentioning

confidence: 99%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared.M Me et th ho od ds s: : Two hundred adult patients randomly allocated to two groups were given 1.5 mg·kg -1 iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg·min -1 in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol.R Re es su ul lt ts s: : There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results.C Co on nc cl lu us si io on ns s: : LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase. Objectif : On a pensé qu'une émulsion de propofol avec une chaîne mi-longue de triglycéride (CLT/CMT) cause moins de douleur à l'injection qu'une émulsion à chaîne longue (CLT) parce que la concentration de propofol diminue pendant la phase aqueuse. Aussi, le propofol avec CLT génère de la bradykinine, causant de la douleur à l'injection, et active le complément, mais ces effets n'ont pas été étudiés avec le propofol CLT/CMT. Pour définir le mécanisme qui réduit la douleur avec le propofol CLT/CMT, nous avons comparé la douleur à l'injection, la génération de bradykinine et l'activation du complément avec l'usage des deux produits de propofol. Méthode : Deux cents patients adultes ont été répartis au hasard en deux groupes et ont reçu 1,5 mg·kg -1 iv de propofol CLT ou CLT/CMT

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Section: Bradykinin Generation and Complement Activationmentioning

confidence: 99%

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Ohmizo

Obara

Iwama

2005

Can J Anesth/J Can Anesth

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“…For reduction the injection pain of propofol, the most studied drug was lidocaine administered before and during its injection [13][14][15][16][17][18]. It was stated in many studies that for reducing the injection pain, adding lidocaine to propofol was more effective than applying IV lidocaine before propofol [4,5,7,[10][11][12][13][14][15][16][17][18][19][20]. Kam et al [8] concluded that there was no significant difference between the injection pain caused by propofol MCT/LCT without lidocaine and standard propofol with 10-mg lidocaine.…”

Section: Discussionmentioning

confidence: 99%

“…Free concentrations of propofol release brandikinin by activating the kinin-kallikrein system with a direct irritation to vessel endothelium (particularly tunica media and intima), thus venous dilatation generates a hyper permeability and this causes pain by providing more contact from propofol to nerve endings [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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

Alparslan¹,

Ak²,

Dinçer³

et al. 2014

Basic Clin Sci

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“…Recently, we demonstrated that the hypnotic activity of propofol, a popular intravenous general anesthetic and one of the most lipophilic drugs, was diminished by simultaneous injection of lipid as a solvent [3]. Injection site pain of propofol is widely known and is considered to result from the increase in free aqueous fraction of the drug [4]. The coadministration of lipid solution could alleviate this pain by the decrease in free propofol caused by the lipid sink.…”

Section: To the Editormentioning

confidence: 99%

Not only bupivacaine but also propofol is sinking in lipid?

2013

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To the Editor:We read with great interest the recent article [1] and editorial [2] by Oda and Ikeda in this journal. The authors clearly demonstrated the effect of lipid emulsion on central nervous system abnormalities induced by bupivacaine toxicity using the unique experimental in vivo animal model. Although many anesthesiologists in developed countries, including Japan, would prefer to choose safer and long-acting local anesthetics, e.g., ropivacaine, basic research on the mechanism of drug toxicity and exploration of treatment for intoxication are absolutely important.Oda concluded that a lipid sink resulting from administration of the emulsion appears to play an important role for various lipophilic agents. Recently, we demonstrated that the hypnotic activity of propofol, a popular intravenous general anesthetic and one of the most lipophilic drugs, was diminished by simultaneous injection of lipid as a solvent [3]. Injection site pain of propofol is widely known and is considered to result from the increase in free aqueous fraction of the drug [4]. The coadministration of lipid solution could alleviate this pain by the decrease in free propofol caused by the lipid sink. Therefore, we hypothesized that not only injection pain but also the effect of the drugs on the central nervous system might be modified by lipid injection, similar to bupivacaine neurotoxicity.Lipid rescue is reported as effective for many other drugs besides bupivacaine. The precise mechanism is not fully understood, and further studies are required. Reducing pain during propofol injection: the role of the solvent. Conflict of interest

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Reducing Pain During Propofol Injection

Cited by 59 publications

References 15 publications

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol

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

Not only bupivacaine but also propofol is sinking in lipid?

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