Incidence of Pain after Intravenous Injection of a Medium-/Long-chain Triglyceride Emulsion of Propofol

Abstract

Background and objective: To assess incidence and intensity of pain on intravenous injection of propofol (CAS 2078-54-8) in an emulsion of medium-chain / long-chain triglycerides (MCT/LCT, 50:50) in patients undergoing different elective surgical interventions.Methods: The new solvent was used for induction of general anesthesia. Spontaneous pain reactions and pain elicited upon questioning were assessed. Patients were asked to grade the pain as mild, moderate or severe. Co-medication with sedative or analgesic drugs, size of the intravenous cannulae, site of injection and administration as a single bolus or in divided doses were recorded.Results: Overall incidence of pain was 28.4 % (390 out of 1375 patients). Twelve percent of the patients complained spontaneously and 16.4 % reported pain after questioning. Pain intensity was graded as mild by 16.7 % of the patients. The incidence of pain was significantly less when using an antecubital vein compared with a forearm or dorsal hand vein (p = 0.017 spontaneously reported pain, p = 0.001 pain elicited upon questioning). The number of patients complaining spontaneously of pain was significantly lower (p = 0.006) for large size than for small and medium size cannulae. Conclusions: The incidence of pain on injection of a medium-/ long-chain tri-glyceride propofol formulation was 28.4 % with 16.7 % of the patients reporting mild pain. The use of an antecubital vein or a large size venous cannula appears to reduce the injection pain. Anesthetics CAS 2078-54-8 Propofol, new solvent Propofol- Lipuro, injection pain, observational study Arzneim.-Forsch./Drug Res. 53, Nr. 9, 621−626 (2003) Arzneim.-Forsch./Drug Res. 53, No. 9, 621−626 (2003) Bachmann-Mennenga et al. − Propofol Arzneim.-Forsch./Drug Res. 53, No. 9, 621−626 (2003) Bachmann-Mennenga et al. − Propofol

Prevention of pain on injection of propofol: systematic review and meta-analysis

“…The primary outcome was the number of patients reporting any pain Studies excluded (n=106): Reviews (n=7) 1 3 4 14-17 Animal studies (n=2) 18 19 Not randomised controlled trials (n=15) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Improper assessment of pain (n=7) [35][36][37][38][39][40][41] Duplicate publication (n=2) 42 43 Methodological concerns (n=15) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] Did not measure pain from propofol injection (n=20) [60][61][62][63][64][65][66][67][68]…”

Pain on propofol injection: Causes and remedies

“…[5] In one observational study of 1375 patients, incidence of pain on injection of MCT/LCT propofol was 28.7%, with 16.6% of patients reporting mild pain. [6] In another study, propofol formulation 6% in Lipofundin MCT/LCT 10% had a similar incidence of pain on injection as LCT propofol containing intralipid 10%. [7] Lipofundin MCT/LCT 10% is a 10% fat emulsion consisting of MCT and LCT, whereas intralipid 10% contains only LCT.…”

Hemodynamic Profile in Rabbits of Fospropofol Disodium Injection Relative to Propofol Emulsion Following Rapid Bolus Injection

“…[9][10][11] Fospropofol disodium is a water-soluble prodrug of propofol that was initially developed in an attempt to circumvent the disadvantages associated with PE. [12][13][14][15][16] PE has been associated with pain-oninjection, 17,18 elevated lipid levels during long-term infusions, [19][20][21][22] and risk of infection due to bacterial contamination. [23][24][25] Propofol is also associated with dose-dependent apnea and hemodynamic depression.…”