Pretreatment with Low-Dose Esketamine for Reduction of Propofol Injection Pain: A Randomized Controlled Trial

Abstract

Background. Propofol-induced injection pain is a common adverse effect during the induction of general anesthesia. The purpose of this study is to investigate the effect of low-dose esketamine in preventing propofol injection pain. Methods. In this double-blind, randomized, controlled trial, patients scheduled for elective ear surgery under general anesthesia received either normal saline (NS), or 40 mg lidocaine, or 0.15 mg/kg esketamine 30 seconds before manual injection of propofol. The primary outcome of this study was the incidence of propofol injection pain. The secondary outcomes included injection pain score, vital signs, total dosage of vasoactive drugs used within 5 minutes after induction, and adverse events related to drugs. Results. A total of 105 patients were included. Compared with the NS group (67%), pretreatment with esketamine and lidocaine significantly reduced the incidence of injection pain to 29% and 33%, respectively (both P < 0.05 ); however, no significant difference was found between the esketamine and lidocaine groups. The median of injection pain score was significantly lower in the esketamine and lidocaine groups (both median (interquartile range) = 0 (0–1)) than that in the NS group (1 (0–2); P < 0.05 ). In addition, compared with the NS and lidocaine groups, preinjection esketamine provided more stable hemodynamic parameters within 5 minutes after induction ( P < 0.05 ). No statistical difference was found in adverse events among the three groups. Conclusions. Pretreatment with a low-dose esketamine can not only reduce the incidence of propofol injection pain but also provide a more stable circulation in patients after anesthesia induction. This convenient, well-tolerated, and economic treatment appears as an option to be routinely applied in clinic practice. Clinical Trial Registration. This trial is registered with https://www.chictr.org.cn/showproj.aspx?proj=136690 (the number for the trial registration isChiCTR2100052742).

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

“…In our study, the propofol–esketamine mixture (ESK-20 group) was effective in preventing PIP (decreased from 63.3% to 33.3%), and no patient reported severe pain. Pretreatment with esketamine (0.15–0.25 mg/kg) before injection of propofol significantly reduced the incidence of PIP ( Li et al, 2022a ; Fu et al, 2022 ). The mechanism by which esketamine reduces PIP may be related to its action on the peripheral NMDA receptors.…”

“…Frontiers in Pharmacology frontiersin.org (0.15-0.25 mg/kg) before injection of propofol significantly reduced the incidence of PIP (Li et al, 2022a;Fu et al, 2022). The mechanism by which esketamine reduces PIP may be related to its action on the peripheral NMDA receptors.…”

Application of Propofol Target-Controlled Infusion Combined with Etomidate in Painless Gastrointestinal Endoscopy: A Prospective, Randomized Controlled Study

“…However, propofol is a cardiovascular depressant and can lead to adverse reactions such as hypotension and bradycardia; these reactions may be attributed to a decrease in cardiac output, peripheral vascular resistance, or both, as well as an increase in venous capacitance or a decrease in sympathetic nervous system basal activity [9] . Meanwhile, the injection pain of propofol is a common adverse reaction [31] . According to previous reports, the incidence of injection pain caused by propofol can reach 28-90% and averages approximately 60-70% [32][33] .…”

The effects of esketamine on blood pressure and hypotension incidence during induction of bariatric surgery: A randomized controlled trial

“…[6] To mitigate this risk, a pharmacological remedy such as esketamine, which is an antagonist of the N-methyl-D-aspartate receptor, is sometimes used in low doses before induction to avoid propofol injection pain and is known to increase blood pressure as a side effect. [14,15] Previous studies observed that this effect of esketamine can be used to improve hemodynamic stability in patients undergoing procedures under general anesthesia. [15][16][17][18][19][20][21][22] In light of the evidence from previous studies, we hypothesize that esketamine may improve blood pressure during the induction phase of the procedure since it stimulates the sympathetic nervous system, making it an ideal drug for the induction of anesthesia in unstable patients.…”

“…[14,15] Previous studies observed that this effect of esketamine can be used to improve hemodynamic stability in patients undergoing procedures under general anesthesia. [15][16][17][18][19][20][21][22] In light of the evidence from previous studies, we hypothesize that esketamine may improve blood pressure during the induction phase of the procedure since it stimulates the sympathetic nervous system, making it an ideal drug for the induction of anesthesia in unstable patients. [23,24]…”