The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia

Tan, Li-Hoon; Hwang, Nian Chih

doi:10.1213/01.ane.0000066357.63011.75

Cited by 21 publications

(11 citation statements)

References 21 publications

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“…Similar to our findings, two other studies suggested decreased anesthetic potency of propofol when administered as lidocaine mixed with propofol in rats [27] and women [10]. In contrast to our finding, two studies showed clinically insignificant effects in the study ranged from 200 : 10 to 200 : 50 propofol/lidocaine mg ratio [28] and 10 : 1 propofol 1%/lodocaine1% volume ratio [29]. …”

Section: Discussionsupporting

confidence: 85%

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

Kim

Cho

Lee

et al. 2010

Korean J Anesthesiol

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BackgroundSimilar to lipid emulsion propofol, microemulsion propofol also causes a high incidence of pain during intravenous injection. Various methods have been used to minimize the incidence and severity of pain on injection of lipid emulsion propofol. In this study, we investigated the effect of a lidocaine mixture on pain induced by microemulsion propofol injection, and sought to determine the optimal dose of lidocaine that could reduce pain on injecting a propofol-lidocaine mixture.MethodsOne hundred sixty (n = 160) patients of American Society of Anesthesiologists physical status class I or II were randomly allocated to four groups: Group A, control; Group B, 20 mg lidocaine; Group C, 30 mg lidocaine; Group D, 40 mg lidocaine. In each patient, pain on microemulsion propofol solution injection was graded as none, mild, moderate, or severe.ResultsThe incidence of pain in groups A, B, C, and D was 97.5%, 80%, 65%, and 50%, respectively. Increasing the lidocaine dose significantly reduced pain (P < 0.05). One patient in Group D (2.5%) had moderate to severe pain, which was significantly lower than groups B (42.5%) and C (32.5%) (P < 0.05).ConclusionsThe lidocaine and propofol mixture is effective in alleviating pain associated with microemulsion propofol injection. Within this dose range and in this patients population, increasing lidocaine dosage significantly reduced pain during injection of microemulsion propofol.

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Section: Discussionsupporting

confidence: 85%

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

Kim

Cho

Lee

et al. 2010

Korean J Anesthesiol

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“…Besides, the analgesic effect of lidocaine on propofol injections not only based on its local anesthetic effect but also on the decrease in pH of the propofol when given as a lidocaine mixture. Tan LH et al, compared the effects of propofol-lidocaine mixture and lidocaine pretreatment in adults on propofol injection pain and the dose of propofol required for the induction of anesthesia 18. They showed no statistically difference between the groups for propofol induced pain and induction dose of propofol like in our study.…”

Section: Discussioncontrasting

confidence: 44%

Prevention of Propofol Injection Pain in Children: A Comparison of Pretreatment with Tramadol and Propofol-Lidocaine Mixture

Borazan¹,

Şahin²,

Kececioglu³

et al. 2012

Int. J. Med. Sci.

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Background: The pain on propofol injection is considered to be a common and difficult to eliminate problem in children. In this study, we aimed to compare the efficacy of pretreatment with tramadol 1 mg.kg-1and propofol-lidocaine 20 mg mixture for prevention of propofol induced pain in children.Methods: One hundred and twenty ASA I-II patients undergoing orthopedic and otolaryngological surgery were included in this study and were divided into three groups with random table numbers. Group C (n=39) received normal saline placebo and Group T (n=40) received 1 mg.kg-1 tramadol 60 sec before propofol (180 mg 1% propofol with 2 ml normal saline) whereas Group L (n=40) received normal saline placebo before propofol-lidocaine mixture (180 mg 1% propofol with 2 ml %1 lidocaine). One patient in Group C was dropped out from the study because of difficulty in inserting an iv cannula. Thus, one hundred and nineteen patients were analyzed for the study. After given the calculated dose of propofol, a blinded observer assessed the pain with a four-point behavioral scale.Results: There were no significant differences in patient characteristics and intraoperative variables (p>0.05) except intraoperative fentanyl consumption and analgesic requirement one hr after surgery among the groups (p<0.05). Both tramadol 1 mg.kg-1 and lidocaine 20 mg mixture significantly reduced propofol pain when compared with control group. Moderate and severe pain were found higher in control group (p<0.05). The incidence of overall pain was 79.4% in the control group, 35% in tramadol group, 25% in lidocaine group respectively (p<0.001).Conclusions: Pretreatment with tramadol 60 sec before propofol injection and propofol-lidocaine mixture were significantly reduced propofol injection pain when compared to placebo in children.

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“…Six agent mixtures with corresponding control mixtures were prepared, as shown in Table 1. The volume of each agent mixed with propofol formulations was determined based on the amounts that had been shown to be effective in reducing propofol‐induced pain in previous studies [13, 14, 16–18, 22].…”

Section: Methodsmentioning

confidence: 99%

Pain on injection with microemulsion propofol

Sim¹,

Lee

Park

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Aqueous free propofol in lipid emulsion elicits pain. • No data on the incidence and severity of injection pain for Aquafol™ (Daewon Pharmaceutical Co., Ltd, Seoul, Korea), a lipid‐free microemulsion propofol, are available. • Two hypotheses involving plasma bradykinin generation have been proposed to explain propofol‐induced pain; one implicates aqueous free propofol, the other implicates the lipid solvent. WHAT THIS STUDY ADDS • Microemulsion propofol produces more frequent and severe pain on injection, an effect that may be attributable to the high concentration of aqueous free propofol. • There was no evidence that plasma bradykinin generation caused propofol‐induced pain. • In addition, agents known to prevent propofol‐induced pain did not decrease aqueous free propofol concentrations. AIMS To evaluate the incidence and severity of injection pain caused by microemulsion propofol and lipid emulsion propofol in relation to plasma bradykinin generation and aqueous free propofol concentrations. METHODS Injection pain was evaluated in 147 patients. Aqueous free propofol concentrations in each formulation, and in formulation mixtures containing agents that reduce propofol‐induced pain, were measured by high‐performance liquid chromatography. Plasma bradykinin concentrations in both formulations and in their components mixed with blood sampled from six volunteers were measured by radioimmunoassays. Injection pain caused by 8% polyethylene glycol 660 hydroxystearate (PEG660 HS) was evaluated in another 10 volunteers. RESULTS The incidence of injection pain [visual analogue scale (VAS) >30 mm] caused by microemulsion and lipid emulsion propofol was 69.7 and 42.3% (P < 0.001), respectively. The median VAS scores for microemulsion and lipid emulsion propofol were 59 and 24 mm, respectively (95% confidence interval for the difference 12.5, 40.0). The aqueous free propofol concentration of microemulsion propofol was seven times higher than that of lipid emulsion propofol. Agents that reduce injection pain did not affect aqueous free propofol concentrations. Microemulsion propofol and 8% PEG660 HS enhanced plasma bradykinin generation, whereas lipid emulsion propofol and lipid solvent did not. PEG660 HS did not cause injection pain. CONCLUSIONS Higher aqueous free propofol concentrations of microemulsion propofol produce more frequent and severe pain. The plasma kallikrein–kinin system may not be involved, and the agents that reduce injection pain may not act by decreasing aqueous free propofol concentrations.

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The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia

Cited by 21 publications

References 21 publications

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine

Prevention of Propofol Injection Pain in Children: A Comparison of Pretreatment with Tramadol and Propofol-Lidocaine Mixture

Pain on injection with microemulsion propofol

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