Effect of 6% hydroxyethyl starch pre-administration for reduction of pain on propofol injection: A placebo-controlled randomised study

Abstract

Background and Aims: Colloids modify the vascular endothelium and prevent contact activation of various substances. Pre-administration of colloids may prevent contact activation of vascular endothelium by propofol. The objective of this study was to evaluate the effect of 6% hydroxyethyl starch (HES) 130/0.4 pre-administration on propofol injection pain. Methods: Adult patients of the American Society of Anesthesiologists physical status I and II patients, 18-65 years old, of either gender and undergoing elective surgery were randomised into two groups. 100 mL bolus of HES or 0.9% normal saline (NS) was administered over three to five minutes through an 18 G cannula placed in the hand or forearm vein, followed by induction with 1% propofol premixed with 2% lidocaine. Pain during propofol injection was assessed every 10 seconds before the loss of verbal contact as 0- no pain; 1- mild pain evident only on questioning after 10 seconds without any obvious discomfort; 2-moderate pain self-reported by patients within 10 seconds with some discomfort; and 3- severe pain accompanied by withdrawing of hand, and behavioural signs. Results: 126 patients completed the study. Overall incidence of pain was significantly higher in the NS group vs HES group (53% vs 28%; P = 0.004; relative risk 1.54, 95% confidence interval 1.13-2.09). Incidence of severe (8% vs 0%) and moderate pain (16% vs 5%) was higher in the NS group, while the incidence of mild pain was comparable (29% vs 23%; NS vs HES). A significant difference was seen in the severity of pain between the groups ( P = 0.002). Conclusion: Pre-administration of 100 mL bolus of 6% HES 130/0.4 significantly reduced propofol injection pain.

Risk of bias in published randomised controlled trials

“…The demographic data of the 27 included articles are given in Table 1 . [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Overall, 13 out of 27 were judged as having a low risk of bias. [ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases.…”

“…[ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases. [ 7 8 11 17 18 19 26 29 ] In domain 1, that is, bias arising from the randomisation process, 3 out of 27 had some concerns regarding biases. [ 25 28 30 ] Rest of the trials were judged as having a low risk of bias.…”

“…[ 25 28 30 ] Rest of the trials were judged as having a low risk of bias. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 29 ] In domain 2, that is, bias due to deviations from intended interventions, 7 out of 27 had some concerns regarding biases. [ 5 8 11 13 14 18 29 ] and the remaining trials were judged as having a low risk of bias.…”

“…[ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 29 ] In domain 2, that is, bias due to deviations from intended interventions, 7 out of 27 had some concerns regarding biases. [ 5 8 11 13 14 18 29 ] and the remaining trials were judged as having a low risk of bias. [ 4 6 7 9 10 12 15 16 17 19 20 21 22 23 24 25 26 27 28 30 ] In domain 3, that is, bias due to missing outcome data, all the were considered as having a low risk of bias.…”

Trends in research in Indian Journal of Anaesthesia – A bibliometric analysis

“…In 11 original articles, newer trends in post-operative pain management were clearly evident. [ 15 16 17 18 19 20 21 22 23 24 25 ] The most notable area of interest was the utility of fascial plane nerve blocks. Fascial plane nerve blocks offer somatic pain relief following the surgery and reduce the requirement for other analgesics, such as opioids.…”