Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol

Abstract

SummaryA randomised, prospective trial was conducted to assess the efficacy of various means of alleviating the pain of subcutaneous lidocaine infiltration. One hundred and twenty-two patients were randomly allocated to different groups to receive buffered lidocaine 1%, warmed lidocaine 1% or infiltration by the counter-irritation technique. A visual analogue pain score was recorded at different stages of cannulation and results showed that pain scores were significantly lower in the group receiving buffered lidocaine 1% (p`0.02) and in the counter-irritation group (p`0.05). Thus buffering lidocaine 1% and administration of lidocaine 1% by the counter-irritation technique is effective in relieving the pain of lidocaine infiltration.Keywords Anaesthetic, local; lidocaine. Procedures, venepuncture. ...................................................................................... Correspondence to: Dr E. L. Ong Accepted: 27 February 1999 It is common practice for anaesthetists to use a subcutaneous infiltration of lidocaine to alleviate the pain of venepuncture with a cannula. While previous studies have shown this to be less painful than insertion of a cannula, even one as small as 22-gauge [1], the pain associated with lidocaine infiltration has at times led to debate about this procedure. It was, therefore, the need to alleviate the 'lidocaine sting' that prompted this study, which compares various means of reducing this pain. Well-tested methods include alkalinisation of lidocaine with sodium bicarbonate solution and warming the lidocaine to body temperature. A less well-known method, counter-irritation, has been suggested to be effective [2]. Previous studies with volunteers have performed testing on the forearm [3, 4], this study aims to test the efficacy of these pain-reducing methods on the dorsum of the hand of patients, which is the common site of venous cannulation. A previous study has shown that the skin sensitivity of different parts of the arm vary with the dorsum of the hand being less sensitive than the volar aspect of the arm. If this is the case it may not be necessary to go to lengths to alleviate lidocaine sting [5]. MethodsAfter approval by the hospital ethics committee and informed consent, 122 unpremedicated ASA grade I and II patients were enrolled into the study. Exclusion criteria included allergy to local anaesthetics and pregnancy. The patients were randomly assigned to one of four treatment groups. Groups A and D received 1% lidocaine at room temperature (20 ЊC) as was the standard practice. Group B received 1% lidocaine buffered by adding 8.4% sodium bicarbonate in the ratio of 1-10 of lidocaine. Group C received 1% lidocaine warmed to 37 ЊC by means of a thermostatically controlled water bath available in all operating theatres.The dorsum of the nondominant hand was cleansed with an alcohol swab and allowed to dry. A quantity (0.5 ml) of the prepared solution in a 2.5-ml syringe was infiltrated subcutaneously via a 27-gauge needle over 5 s. In group D, counter-irritation ...

Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain

“…3 17 In addition to cold, non-steroidal antiinflammatory drugs such as ketorolac are also demonstrated to reduce the propofol injection pain aggravated by the release of local kininogens. 18 In a recent study, Lee and colleagues 19 showed that acetaminophen selectively suppresses peripheral PG E2 release and increases COX-2 gene expression in a clinical model of acute inflammation. Similarly, in another recent study, bradykinin, a bradykinin B2-receptor agonist, has been shown to enhance both basal and lipopolysaccharide-induced PG E2 synthesis in rat neonatal glial cells in culture.…”

“…Moreover, non-steroidal anti-inflammatory drugs (NSAIDs) have been shown to diminish prostaglandin (PG) synthesis and inhibit kinin cascade, thereby reducing pain on injection of propofol. 6 As an alternative to NSAIDs and selective COX-2 inhibitors, acetaminophen, whose action at a molecular level is still not known, is widely used for pain management. Although acetaminophen does not inhibit COX enzymes at therapeutic concentrations in vitro, it is shown to inhibit a variant of COX enzymes in vivo.…”

Comparison of Acetaminophen (with or without Tourniquet) and Lidocaine in Propofol Injection Pain

“…By an indirect action on the endothelium, it also activates the kallikrein-kinin system, thereby producing venous dilation and hyperpermeability, increasing the contact between propofol and the free nerve endings (19). Moreover, NSAIDs via decreasing prostaglandin synthesis and inhibit the kinin cascade, thus As an alternative to NSAIDs, acetaminophen, whose action at a molecular level is still not known, has been used for management propofol related pain (20). Although it does not inhibit cyclooxygenase (COX) enzymes at therapeutic concentrations in vitro, Simmons et al (21) demonstrated a COX-2 variant, which was sensitive to acetaminophen in vivo.…”

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

“…It produces a good quality of anaesthesia and rapid recovery. 1,5 Chemically, propofol belongs to the group of sterically hindered phenols. Hence, like other phenols propofol irritates the skin, mucous membrane and venous intima.…”

“…However, the activation of pain mediators such as the release of a kininogen from the vein wall triggering a local kinin cascade system during intravenous injection has been suggested. 5 The free fraction of propofol has been implicated, which explains a slight delay before pain is experienced. 6 Scott et al speculated that the injection pain is caused by activation of the kallikrein-kinin system either by propofol or by the lipid solvent, thereby generating kinins, probably bradykinin.…”