Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults

Background and Aims:Propofol (2, 6-di-isopropylphenol) used for the induction of anaesthesia often causes mild to severe pain or discomfort on injection. We designed this double-blind study to compare the efficacy of methylprednisolone and lignocaine in reducing the pain of propofol injection in patients scheduled for cardiac surgery.Methods:A total of 165 adult patients, scheduled for elective cardiac surgery, were divided into three groups: saline (group S, n = 55), lignocaine 20 mg (Group L, n = 55) and methylprednisolone 125 mg diluted into 2 ml of distilled water (Group MP, n = 55). Drugs were administered after tourniquet application and occlusion was released after 1 min and 1/4th of the total dose of propofol (2 mg/kg) was administered at the rate of 0.5 ml/s. Pain on propofol injection was evaluated by four-point verbal rating scale. Statistical methods used included Student's t-test and Chi-square test/Fisher's exact test.Results:The overall incidence of pain was 70.9% in the saline group, 30.9% in the lignocaine group and 36.4% in the methylprednisolone group. The intensity of pain was significantly less in patients receiving methylprednisolone and lignocaine than those receiving saline (P < 0.012).Conclusion:Pre-treatment with intravenous methylprednisolone was found to be as effective as lignocaine in reducing propofol injection-induced pain.

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“…[19] Among these studies, the most commonly accepted technique is the administration of lignocaine just before the injection of propofol. [20]…”

Section: Discussionmentioning

confidence: 99%

Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised, double-blind, prospective study in adult cardiac surgical patients

et al. 2016

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“…48 In another study done by Johnson RA and collegues, it was seen that pain was reduced significantly in all the groups in which lidocaine was used and the degree of pain alleviation was in direct proportion to the dose of lidocaine given. 46 Present result is consistent with the study done by Basappa G and collegues, who studied the effect of lignocaine, ondansetron and ramosetron on attenuation of propofol injection induced pain.…”

Section: Discussionmentioning

confidence: 99%

A prospective, randomized, double blind study to evaluate and compare the efficacy of lidocaine, ramosetron and tramadol pre-medication, in attenuating the pain caused due to propofol injection

et al. 2017

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Background: Propofol is a popular induction agent, especially for short cases, day care surgeries and when a laryngeal mask is to be used. It produces a good quality of anaesthesia and rapid recovery. Pain on injection of propofol has been reported and is an important limitation of its use. A multitude of interventions: pharmacological as well as non-pharmacological, have been tried for the attenuation of pain caused due to propofol injection. In our study, we evaluated and compared the efficacy of lidocaine, ramosetron and tramadol in attenuating pain on propofol injection. Methods: A total of 180 patients belonging to American Society of Anesthesiologists (ASA) grade I and II, of either sex, aged between 21 to 50 years undergoing elective surgery under general anaesthesia, were taken up for the study and were divided into group A, B and C. Group A received 2ml of 2% (40mg) lidocaine, Group B received 2ml of ramosetron (0.3mg) and Group C received 1mg/kg of tramadol in 0.9% normal saline to make a total solution of 2ml. Venous occlusion was done by compressing forearm with tourniquet to increase the local concentration of drug after establishing an intravenous access. The study drug was injected over 10 seconds and then occlusion was removed after 60 seconds, followed by giving 25% of the total calculated dose (2.5mg/kg) of propofol (1% w/v in lipid base) injected over 20 seconds. This was followed by asking the patient about the severity of pain felt. The intensity of pain was graded using verbal rating scale (McCrirrick and Hunter) and was assessed at 0, 5, 10, 15 and 20 seconds, as after 20 seconds, the patient would be under the influence of propofol. Results: Lidocaine showed the best efficacy in attenuating propofol injection pain amongst the 3 groups recorded at 5 (95%), 10 (91.7%) and 15 seconds (98.3%). In addition to reducing the incidence of pain, it also reduced its severity, with majority of patients experiencing only mild pain. Ramosetron ranked 2 nd in the overall reduction of propofol pain, with lowest incidence of propofol pain amongst 3 groups, recorded at 0 (98.3%) and 20 seconds (95%) of propofol injection. However, ramosetron failed in reducing severity of pain, with a significant number of patients experiencing moderate and severe pain. Tramadol ranked 3 rd in the overall attenuation of propofol pain and showed lowest incidence of pain at 0 seconds (93%) of propofol injection. Conclusions: All the three study drugs viz lidocaine, ramosetron and tramadol cause a significant decrease in propofol injection pain with lidocaine as the most efficacious drug amongst the 3 drugs followed by ramosetron and tramadol. Lidocaine has an added advantage of decreasing incidence and severity of pain associated with propofol and ramosetron prevents postoperative nausea and vomiting.

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“…Studies have premixed the drug with propofol 16 or given it separately before propofol injection with or without application of a tourniquet. 15 A meta-analysis by picard and tramer concluded that pain on propofol injection was 70 % and lignocaine was the best drug to reduce pain. 19 Massad IM et al compared different duration of venous occlusion 15 sec, 30 sec and 60 sec after lignocaine injection to determine which was most effective and concluded that different duration of venous occlusion was not statistically significant in reducing pain on propofol injection.…”

Section: Figmentioning

confidence: 99%

“…20 However Sedat kaya et al in his study was able to show that pretreatment of lignocaine with venous occlusion was more effective in reducing pain on propofol injection when comparing without venous occlusion. 15 We applied venous occlusion for one minute with tourniquet with a pressure of 100 mmHg.…”

Section: Figmentioning

confidence: 99%

Comparing the Effectiveness of Two Different Doses of Intravenous Lignocaine in Reducing the Incidenc E of Pain on Propofol Injection

Balaji¹,

Anand²,

Anand³

2015

jemds

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INTRODUCTION:Propofol in spite of its advantages as an induction agent has the drawback of pain on injection which can be very distressing to the patients. Pain on Propofol injection is estimated to be around 28-90%.Many drugs have been tried to attenuate the pain of Propofol injection. Lignocaine has been the most studied drug in varying dosages, as a mixture with Propofol, given alone and with and without venous occlusion. AIM: To compare the effectiveness of two doses of Lignocaine 25mg,50mg and a placebo in attenuating the pain of propofol injection with 60 seconds of venous occlusion using a tourniquet to a pressure of 100 mmHg. MATERIAL AND METHODS: a prospective randomized double blinded study of ASA I and II patients divided into three groups. Group 1(n=20) received 5 ml normal saline, group 2 (n=20) received 25 mg lignocaine diluted to 5ml, group 3 (n=20) received 50 mg lignocaine diluted to 5ml. All patients had a tourniquet applied for venous occlusion for 60 seconds at 100 mmHg. After propofol injection pain was evaluated using verbal rating scale and behavioral changes. STATISTICAL ANALYSIS: The obtained data was analyzed statistically using the one way analysis of variance test and the chi-square test for the pain score. RESULTS: Propofol produced pain on injection in 80% of patients which was reduced to 45% with 25mg of lignocaine with venous occlusion and further reduced to 25% with 50 mg lignocaine with venous occlusion. None of the lignocaine treated patients had severe pain. CONCLUSION: Lignocaine with venous occlusion is effective in attenuating the pain on propofol injection. 50 mg of intravenous lignocaine with venous occlusion being more effective than 25 mg of intravenous lignocaine with venous occlusion.

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Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults

Cited by 21 publications

References 13 publications

Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised, double-blind, prospective study in adult cardiac surgical patients

Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised, double-blind, prospective study in adult cardiac surgical patients

A prospective, randomized, double blind study to evaluate and compare the efficacy of lidocaine, ramosetron and tramadol pre-medication, in attenuating the pain caused due to propofol injection

Comparing the Effectiveness of Two Different Doses of Intravenous Lignocaine in Reducing the Incidenc E of Pain on Propofol Injection

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