Pharmacological control of pain during propofol injection: a systematic review and meta-analysis

Bakhtiari, Elham; Mousavi, Seyed Hadi; fard, Mohammad Gharavi

doi:10.1080/17512433.2021.1919084

Cited by 23 publications

(20 citation statements)

References 51 publications

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“…First, propofol is an intravenous anesthetic, pain on injection is a major disadvantage. Many studies have been carried out to eliminate injection pain caused by propofol, but they are not successful yet ( 48 ). Secondly, it is necessary to establish a peripheral venous channel for propofol anesthesia.…”

Section: Discussionmentioning

confidence: 99%

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

Zhao

Feng²,

Liu³

et al. 2022

Front. Surg.

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BackgroundPropofol and sevoflurane are the most used anesthetics for pediatric surgery. Emergence agitation, postoperative nausea and vomiting and postoperative pain are the primary adverse effect of these general anesthetics. Many clinical studies had compared the safety of propofol and sevoflurane in pediatric surgery, but the results were controversial.ObjectivesTo evaluate the evidence surrounding the safety of propofol versus sevoflurane for general anesthesia in children.MethodsDatabases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Vip Data were searched to collect relevant articles. Trials were strictly selected according to previously defined inclusion and exclusion criteria. RevMan 5.3 software was used for meta-analyses.ResultsTwenty randomized controlled trials recruiting 1,550 children for general anesthesia were included, with overall low-moderate methodological quality. There was evidence that compared with sevoflurane anesthesia, propofol anesthesia significantly decreased the incidence of emergence agitation (OR = 4.99, 95% CI, 3.67–6.80; P < 0.00001), postoperative nausea and vomiting (OR = 1.91, 95% CI, 1.27–2.87; P = 0.002) and postoperative pain (OR = 1.72, 95% CI, 1.11–2.64; P = 0.01) in children. However, patients who received sevoflurane tended to have shorter times to eye opening (MD = −2.58, 95% CI, −2.97– −2.19; P < 0.00001) and times to extubation (MD = −1.42, 95% CI, −1.81– −1.02; P < 0.00001).ConclusionsThis review reveals that the children who received propofol anesthesia had the lower risks of emergence agitation, postoperative nausea and vomiting and postoperative pain when compared with sevoflurane anesthesia. But the children who received sevoflurane recovered slightly faster than those received propofol. Considering the limitations of the included studies, better methodological quality and large controlled trials are expected to further quantify the safety of propofol and sevoflurane for general anesthesia in children.

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Section: Discussionmentioning

confidence: 99%

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

Zhao

Feng²,

Liu³

et al. 2022

Front. Surg.

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“…Größter klinischer Nachteil von Propofol ist der Injektionsschmerz, der bei bis zu 90 % der Fälle beschrieben wird und dessen Mechanismus weiterhin unklar ist [12]. Wägt man die Möglichkeiten ab, erscheint bei Kindern die unmittelbare Vorweggabe von Lidocain in einer Dosierung von 1 mg/kgKG und einer Höchstdosis von 20 mg am geeignetsten.…”

Section: Zu Beachten/nachteile Von Propofolunclassified

Sichere und passende Pharmakotherapie in der Kinderanästhesie

Kaufmann¹,

Schindler²

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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Sichere und passende Pharmakotherapie bei Kindern erfordert die Kenntnis von altersgruppenspezifischen Besonderheiten bezüglich der Pharmakologie und der Dosierung von Medikamenten. Zusätzlich müssen Aspekte der Medikamentensicherheit beachtet werden. Diese Übersicht zeigt Grundprinzipien auf und bespricht die wichtigsten Fakten, weitere Recherchen in pädiatrischen Datenbanken werden empfohlen ( ).

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“…It is currently believed that high concentrations of free propofol can induce pain through direct stimulation and activation of the kallikrein-kinin system, activation of nociceptive cis-receptor potential ion channels, and changes in osmotic pressure [ 4 ]. Prophylactic methods such as IV pre-injection of lidocaine, opioids, ketamine, benzodiazepines, metoclopramide, flurbiprofen axetil, cooling, heating or diluting the propofol liquid, or choosing a larger vein for cannulation can reduce the incidence and intensity of propofol injection pain to varying degrees by blocking the pain-inducing mechanism of propofol [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…The burning pain from propofol infusion travels along the blood vessels, causing discomfort and anxiety in patients, and may even result in a traumatic anesthesia experience, making propofol infusion-related pain the major problem encountered in clinical anesthesia practice [ 3 ]. More researchers are studying different medications and methods to relieve IV propofol pain, increase comfort during anesthesia, and improve patient satisfaction [ 4 , 5 ]. Among the many proposed methods of pain control, pre-injection of ketamine is an effective method that reduces propofol injection pain through local and central analgesic effects at a recommended dose of 0.3 mg/kg [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon’s up-and-down method: a double-blind, prospective clinical study of drug dose response

et al. 2022

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Background Propofol is an intravenous (IV) anesthetic medication widely used for procedural sedation, operative anesthesia, and in intensive care unit (ICU), but the incidence of pain during IV infusion can reach 28–90%. Ketamine can attenuate pain associated with IV propofol injection through local and central analgesic effects. Ketamine is gradually being transitioned to its S-enantiomer, esketamine, which has a similar mechanism of action. The purpose of our study is to determine the half effective dose (ED50), 95% effective dose (ED95), and 99% effective dose (ED99) of esketamine for attenuating propofol injection pain using Dixon’s up-and-down method to provide a reference for optimal dose selection for surgeries and procedures. Methods Thirty gynecological patients undergoing hysteroscopic surgery were enrolled in a sequential method to determine the effective dose of esticketamine for analgesic propofol injection in order of operation. This study was based on the sequential allocation up-and-down rule designed by Dixon, and each patient was induced by esticketamine combined with propofol. During induction, the target dose of esketamine was first given via venous access in the left hand of the patient, and 30 s later, a fixed dose of 2 mg/kg (1 ml/s) of propofol was given. Patient perception of pain was scored with the verbal rating scale (VRS) every 5 s after the start of the propofol infusion, and the evaluation was stopped once the patient became unresponsive. The dosage of esketamine was increased or decreased up or down according to the patient’s pain response. The initial dose of esketamine was 0.2 mg/kg, and the gradient of adjacent dose was 0.02 mg/kg. If the pain response assessment of the upper patient was positive (+), the dose of esselketamine in the next patient was increased by 0.02 mg/kg; if the pain response assessment of the upper patient was negative (−), the dose of esselketamine in the next patient was decreased by 0.02 mg/kg. The tests were carried out sequentially, with the pain response changing from positive to negative or from negative to positive, and the tests were stopped after at least 6 crossover points, and the effective dose of esticketamine was calculated using probit probability regression analysis. Results The ineffective group comprised patients with a positive pain response and the effective group comprised patients with a negative pain response. The 95% CI was set as the confidence interval of effective dose ED value，and we found esketamine’s ED50 = 0.143 mg/kg (0.120, 0.162 mg/kg), ED95 = 0.176 mg/kg (0.159, 0.320 mg/kg), and ED99 = 0.189 mg/kg (0.167, 0.394 mg/kg). The esketamine dose and VRS score during propofol injection were significantly different between the two groups (P < 0.05), whereas surgical duration, emergence time, visual analogue scale (VAS) score of postoperative uterine contraction pain, and Riker sedation/anxiety scale (SAS) score were not significantly different. Bradycardia occurred in only one patient during anesthesia induction, while hemodynamics was stable in the rest of the patients without obvious adverse reactions. Conclusion Small doses of esketamine combined with propofol can be safely and effectively used for hysteroscopic surgery. We recommended a dose of 0.2 mg/kg IV esketamine before induction of anesthesia to reduce the pain of propofol injection. Trial registration Chinese Clinical Trial Registry ChiCTR2100048951. Date of registration: July 19, 2021.

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Pharmacological control of pain during propofol injection: a systematic review and meta-analysis

Cited by 23 publications

References 51 publications

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials

Sichere und passende Pharmakotherapie in der Kinderanästhesie

Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon’s up-and-down method: a double-blind, prospective clinical study of drug dose response

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