Can adding Ephedrine to Admixture of Propofol & Lidocaine Overcome Propofol Associated Hemodynamic Changes and Injection Pain?

Abstract

There are numerous studies researching ways to alleviate injection pain for propofol. The most frequently used agent for this purpose has been lidocaine that is used before or with propofol [13][14][15]. There are also studies on the use of hypnotic agents (thiopental sodium, ketamine etc), opiates (alfentanil, sufentanil, remifentanil), dexmedetomidine, magnesium, nonsteroidal analgesic medication, antiemetics and physical applications such as cold packs to alleviate injection pain [13,14,[16][17][18][19][20][21].

A Prospective Study on the Predictability of Propofol Injection Pain

“…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]. However, the most common application in clinical settings is the application of lidocaine before propofol or an admixture of propofol with lidocaine [18][19].…”

“…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].…”

“…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].…”