Propofol: clinical strategies for preventing the pain of injection

Abstract

Summary Eight modes of administration of propofol were assessed in order to minimise the pain of injection. An intravenous bolus injection in the antecubital fossa was the only approach that caused no pain. When administered intravenously in the dorsum of the hand the pain score and the number of patients who experienced pain was reduced significantly by mixing the agent with lignocaine when compared with a bolus injection. Slowing the speed of injection caused the greatest discomfort. An indirect biochemical mechanism for the pain is proposed.

Conditions for laryngeal mask insertionA comparison of propofol versus sevoflurane with or without alfentanil

“…However, propofol has its own side-effects such as pain on injection [8,9] and greater respiratory depression [10]. Sevoflurane is suitable for quick inhalational induction technique even in high concentrations because of its low blood gas solubility (0.69) [11] and minimal respiratory irritant effect [12].…”

Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain.

“…[2,4,[14][15][16][17] Hovewer, even in patients who received most popular lidocaine treatment, the incidence of pain has been reported as frequent as 32%-48%. [15] Propofol is an excellent anesthetic that belongs to the group of phenols, which can irritate the skin, mucous membrane and venous intima.…”

“…These include the addition of lidocaine, cooling or warming the drug, diluting the propofol solution, injection of propofol into a large vein, previous injection of ondansetron, granisetron, metoclopromide, magnesium, thiopental with or without tourniquet. [1][2][3][4][5][6][7] Esmolol is an ultra short acting, cardioselective beta-1 adrenergic receptor antagonist. [8] It is effective in preventing adrenergic responses to several perioperative stimuli, including laryngoscopy, endotracheal intubation with tracheal intubation, intraoperative events and tracheal extubation.…”

Placebo-controlled comparison of using lidocaine or ketamine to reduce the pain during injection of propofol containing a mixture of medium-chain triglyceride/long-chain triglyceride

“…For reduction the injection pain of propofol, the most studied drug was lidocaine administered before and during its injection [13][14][15][16][17][18]. It was stated in many studies that for reducing the injection pain, adding lidocaine to propofol was more effective than applying IV lidocaine before propofol [4,5,7,[10][11][12][13][14][15][16][17][18][19][20]. Kam et al [8] concluded that there was no significant difference between the injection pain caused by propofol MCT/LCT without lidocaine and standard propofol with 10-mg lidocaine.…”

“…Free concentrations of propofol release brandikinin by activating the kinin-kallikrein system with a direct irritation to vessel endothelium (particularly tunica media and intima), thus venous dilatation generates a hyper permeability and this causes pain by providing more contact from propofol to nerve endings [3][4][5][6][7].…”