Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine

Honarmand, Azim; Safavi, Mohammadreza

doi:10.1016/j.acpain.2008.01.001

Cited by 15 publications

(13 citation statements)

References 46 publications

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“…Magnesium is not only the physiological calcium channel blocker, but also an antagonizer of NMDA receptors, which may interfere in the ion channels of K + and Ca 2+ , resulting in reduction of pain perception [20] . In previous studies [5,21,22] , pretreatment with magnesium sulfate was effective in the prevention of propofol-induced pain without considering injection pain from magnesium itself. Incidence of propofol injection pain in a study by Honarmand et al was 34% with magnesium sulphate 2.48 mmol pretreatment [21] .…”

Section: Discussionmentioning

confidence: 97%

“…In previous studies [5,21,22] , pretreatment with magnesium sulfate was effective in the prevention of propofol-induced pain without considering injection pain from magnesium itself. Incidence of propofol injection pain in a study by Honarmand et al was 34% with magnesium sulphate 2.48 mmol pretreatment [21] . Agarwal et al reported that the incidence was 34% with magnesium sulfate 50% (2 mL) pretreatment [5] .…”

Section: Discussionmentioning

confidence: 97%

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Efficacy of different fluids preload on propofol injection pain: A randomized, controlled, double-blinded study

Yuan

Luo

Liu

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA I-II adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 mL (P100 group), 250 mL (P250 group), 500 mL (P500 group), 0.9% saline 500 mL (N500 group) or Gelofusine 500 mL (G500 group) was completed within 30 min, respectively, Propofol (0.5 mg/kg, 1%) was injected at a rate of 0.5 mL/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively (P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups (P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group (62.5%) (N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group (P<0.05) and G500 group (P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 mL before propofol injection is effective in alleviating propofol-induced pain.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Efficacy of different fluids preload on propofol injection pain: A randomized, controlled, double-blinded study

Yuan

Luo

Liu

et al. 2016

J. Huazhong Univ. Sci. Technol. [Med. Sci.]

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“…Magnesium sulfate and lidocaine doses were based on prior studies. 3, 12, 14, 15 Exclusion criteria included age less than 18 years, allergy to local anesthetics or magnesium sulfate, end stage renal disease, pregnancy, incarceration, patients requiring a rapid sequence induction and intubation, refusal to participate, and current participation in another clinical study.…”

Section: Methodsmentioning

confidence: 99%

Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial

et al. 2014

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Purpose Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain. Methods After IRB approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (50 mg), magnesium sulfate (0.25 mg), lidocaine (50 mg) plus magnesium sulfate (0.25 mg), or 0.9% sodium chloride. Following pretreatment, propofol (50 mg) was administered and subjects were questioned regarding injection site pain and observed for behavioral signs of pain. Results Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (57%), followed by those pretreated with placebo (46%), lidocaine plus magnesium sulfate (41%), and then lidocaine (29%; p=0.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p=0.031 and p=0.0003, respectively). Conclusions In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine. An improved, receptor-based understanding of the mechanism of propofol injection pain remains needed.

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“…Magnesium blocks NMDA receptor currents in a voltage-dependent manner by blocking the receptor channel. [ 16 17 18 19 ] Guler et al . compared low-dose magnesium and ketamin in preventing the injection pain of etomidate and found ketamin to be superior.…”

Section: Discussionmentioning

confidence: 99%

“…compared low-dose magnesium and ketamin in preventing the injection pain of etomidate and found ketamin to be superior. [ 17 ] In a study of magnesium sulfate pretreatment to alleviate pain on propofol injection, a comparison with ketamine or lidocaine, Honarmand and Safavi[ 18 ] noted that IV magnesium, ketamine, and lidocaine pretreatment are equally effective in attenuating propofol-induced pain. One previous study showed that MgSO 4 620 mg was effective in reducing severity of myoclonic muscle movements induced by etomidate.…”

Section: Discussionmentioning

confidence: 99%

Magnesium sulfate versus Lidocaine pretreatment for prevention of pain on etomidate injection: A randomized, double-blinded placebo controlled trial

et al. 2015

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Objective:Etomidate is an imidazole derivative and formulated in 35% propylene glycol. When given without a rapid lidocaine injection, etomidate is associated with pain after injection. Magnesium (Mg) is a calcium channel blocker and influences the N-methyl-D-aspartate receptor ion channel. The aim of the study is to evaluate the efficiency of preemptive injection of magnesium sulfate and lidocaine on pain alleviation on etomidate intravenous injection.Methods:In a randomized, double-blinded trial study, 135 adult patients scheduled for elective outpatient or inpatient surgery were divided into three groups. Group M received 620 mg magnesium sulfate, Group L received 3 ml lidocaine 1% and Group S received normal saline, all in a volume of 5 mL followed by a maximal dose of 0.3 mg/kg of 1% etomidate. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 = severe pain at the time of pretreatment and etomidate injection.Findings:About 60% of patients in the control group had pain during etomidate injection as compared to 22.2% and 40% in the lidocaine and magnesium sulfate groups, respectively. There was difference in induction pain score between three treatment groups, significantly (P = 0.01) and observed differences in pain scores between “normal saline and lidocaine group” (P < 0.001) and “normal saline and magnesium sulfate groups” were statistically meaningful (P = 0.044).Conclusion:Intravenous magnesium sulfate and lidocaine injection are comparably effective in reducing etomidate-induced pain.

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Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine

Cited by 15 publications

References 46 publications

Efficacy of different fluids preload on propofol injection pain: A randomized, controlled, double-blinded study

Efficacy of different fluids preload on propofol injection pain: A randomized, controlled, double-blinded study

Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial

Magnesium sulfate versus Lidocaine pretreatment for prevention of pain on etomidate injection: A randomized, double-blinded placebo controlled trial

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