Dexmedetomidine versus ketamine infusion to alleviate propofol injection pain: A prospective randomized and double-blind study

Abstract

Background and Aims:The use of propofol as the most common induction agent and the high prevalence of propofol injection pain (PIP) highlight the significance of finding the ideal combination of drug, dosage and mode of administration of premedicants to alleviate PIP. A number of bolus drugs with variable efficacy have been studied to reduce PIP. The aim of our study was to assess the efficacy of single dose intravenous (IV) infusion of dexmedetomidine 0.5 μg/kg compared with ketamine 0.5 mg/kg to alleviate PIP.Methods:In this prospective, randomised and double-blind study, 108 patients undergoing elective surgeries under general anaesthesia were randomly allocated to two groups: Group D to receive dexmedetomidine 0.5μg/kg or Group K to receive ketamine 0.5 mg/kg in 20 ml of normal saline over 10 min. Immediately after the infusion, 1% propofol 2 mg/kg IV was injected over 25 s. The patients were assessed for pain every 5 s by asking the question ‘does it hurt?’ until the loss of consciousness. The pain scoring was done using McCririck and Hunter scale. Statistical analysis was done using SPSS 17.0.Results:The incidence of PIP and moderate-severe PIP was higher with Group D (79.6%; 16.7%) compared with Group K (40.7; 1.9%) (P < 0.001; 0.016). No patient in either group had arm withdrawal upon propofol injection. The incidence of hypertension and tachycardia was statistically significant in Group K as compared to Group D (P = 0.027).Conclusion:There was no difference in elimination of the arm withdrawal response and in incidence of moderate to severe PIP between the groups.

Efficacy and Safety of Ketamine Compared with Placebo and Other Medications for Preventing Propofol Injection Pain in Adults: A Systematic Review and Meta-Analysis

“…Two RCTs 34 , 35 compared the incidence of PIP in the ketamine and dexmedetomidine groups. Meta-analysis using a fixed-effects model and Mantel-Haenszel method revealed a significantly lower incidence of PIP in the ketamine group as compared with the dexmedetomidine group (41.35% versus 79.81%, RR = 0.52, 95% CI = [0.40, 0.66], P < 0.00001) ( Figure 5 ).…”

“…Two studies 34 , 35 evaluated the PIP scores of the ketamine and dexmedetomidine groups using the VRS. The results of the meta-analysis are presented in Figure 10 .…”

“…Assessments of the risk of bias are presented in Figure 2. Regarding the randomization process, nine studies 25,27,[29][30][31][32][33][34][35] provided detailed information on random sequence generation, allocation concealment, and similar demographics, and were assessed as low risk, while the remaining studies 24,26,28,36 were rated as having some concerns due to insufficient information. All studies were assessed as low risk concerning deviations from the intended interventions and missing outcome data.…”

“…With regard to the measurement of outcome, one study 24 was assessed as high risk because the outcome assessors were not blinded. In terms of the selection of the reported result, except for two studies, 24,25 the rest [26][27][28][29][30][31][32][33][34][35][36] did not provide detailed information about trial registration and were assessed as having some concerns. The overall bias rating equals that of the worst domain.…”

“…The incidence of severe PIP was significantly lower in the ketamine group compared with the lidocaine group (2.78% versus 12.85%, RR = 0.34, 95% CI = [0.21, 0.56], P < 0.0001). Ketamine versus Dexmedetomidine Two studies 34,35 evaluated the PIP scores of the ketamine and dexmedetomidine groups using the VRS. The results of the meta-analysis are presented in Figure 10.…”