Heated carrier fluids in decreasing propofol injection pain: a randomized, controlled trial

Abstract

BackgroundPropofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain.MethodsA randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II. Patients were allocated into the following 3 groups: 1) Group W (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to propofol injection; 2) Group L (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to 0.5 mg/kg 1%lidocaine 1 minute before propofol injection; 3) Group C (control group, n = 30) who received 200 ml of room temperature fluids prior to propofol injection. Pain was evaluated using verbal pain score (VPS).ResultsGroup W and Group L showed significant reduction (P = 0.001) in the incidence and severity of injection pain compared to Group C. VPS scores were significantly lower in Group W and Group L compared to those of Group C. Incidence of propofol injection pain was statistically different between Group W (P = 0.005) and Group L (P = 0.037) compared to Group C, but not statistically different between Group W and Group L (P = 0.432).ConclusionsBoth sole injection of heated carrier fluids and the combination of 0.5 mg/kg 1%lidocaine pretreatment effectively reduced propofol injection pain.

Introduction of a pilot study

“…In addition, the suitability of the method for data collection must be tested. Let us review the study by Youn and Hsu [ 6 ], where the authors compared the methods for pain reduction with a propofol injection. In the pilot study, the following four methods were tested in order to find the most appropriate method for the main trial: Group T received an injection of 0.5 mg/kg of 1% lidocaine after applying a tourniquet; Group H received an injection of 0.5 mg/kg of 1% lidocaine after the injection of 40–41℃ saline solution (200 ml); Group L received an injection of 0.5 mg/kg of 1% lidocaine after an injection of room temperature (23–24℃) saline solution (200 ml); and Group HL received an injection of 0.5 mg/kg of 1% lidocaine at 41℃.…”

Comparing the effects of dezocine with lidocaine on prevention of propofol injection pain in adults: a prospective randomized double-blind trial

“…Other effective non-pharmacological approaches, or combinations of pharmacological approaches, have been recommended to relieve PIP including warming propofol, venous occlusion with a tourniquet, applying microfiltration and changing the lipid composition [3,12,17,23,24]. However, no method could eliminate PIP completely and most of these methods were not routinely available in clinical practice, except venous occlusion with a tourniquet.…”

“…Previous studies have assessed various methods to alleviate PIP, including changing the injection speed, warming up propofol, choosing a large vein and the addition of some drugs [5][6][7][8][9][10][11][12][13]. At present, lidocaine is the most common drug used to relieve PIP.…”

Effects of warmed carrier fluid on nefopam injection-induced pain

“…The calculated rate (90 mg/h) was insufficient to control acute pain and was lower than that used in this study (108 mg/h). We referred to previous studies of the relationship between temperature and pain during injection [ 12 13 14 ], in hopes of finding a way to infuse quickly with minimal pain.…”

“…Previous studies have suggested that injection pain is reduced by thermal vasodilation [ 12 13 14 ]. While several studies reported vasodilatory effects after heating for more than 20 minutes [ 21 22 23 ], it is doubtful whether heating for less than 5 minutes caused vasodilatory effects in previous studies, or in this study.…”