Thiopentone pretreatment for propofol injection pain in ambulatory patients

Abstract

This study investigated propofol injection pain in patients undergoing ambulatory anaesthesia. In a randomized, double-blind trial, 90 women were allocated to receive one of three treatments prior to induction of anaesthesia with propofol. Patients in Group C received 2 ml normal saline, Group L, 2 ml, lidocaine 2% (40 mg) and Group T, 2 ml thiopentone 2.5% (50 mg). Venous discomfort was assessed with a visual analogue scale (VAS) 5-15 sec after commencing propofol administration using an infusion pump (rate 1000 micrograms.kg-1.min-1). Loss of consciousness occurred in 60-90 sec. Visual analogue scores (mean +/- SD) during induction were lower in Groups L (3.3 +/- 2.5) and T (4.1 +/- 2.7) than in Group C (5.6 +/- 2.3); P = 0.0031. The incidence of venous discomfort was lower in Group L (76.6%; P < 0.05) than in Group C (100%) but not different from Group T (90%). The VAS scores for recall of pain in the recovery room were correlated with the VAS scores during induction (r = 0.7045; P < 0.0001). Recovery room discharge times were similar: C (75.9 +/- 19.4 min); L 73.6 +/- 21.6 min); T (77.1 +/- 18.9 min). Assessing their overall satisfaction, 89.7% would choose propofol anaesthesia again. We conclude that lidocaine reduces the incidence and severity of propofol injection pain in ambulatory patients whereas thiopentone only reduces its severity.

Current Perspectives on Pain upon Injection of Drugs

“…[68][69][70]102 If necessary, the drug product labeling may include a recommendation that a specific vehicle or local anesthetic or other protective agent be administered concurrently with the drug. 40,41,43,45,47,57,66,[76][77][78][79]82,83,[87][88][89]91,[93][94][95]100,101,107,108,116,121 The addition of compounds such as procaine or lidocaine to an injection will block the transmission and perception of pain (see mediation of pain) associated with injection via their action on sodium receptors. However, the question that needs to be addressed is whether this is a desirable to utilize this multiple drug approach for long-term therapy.…”

Un mélange de 3 mg·kg−1 de propofol et de 3 mg·kg−1 de thiopental réduit la douleur à l’injection d’anesthésique chez les enfants

“…Adult studies using thiopentone demonstrated that pretreating a vein with 50 mg of thiopentone prior to propofol injection was not as efficacious in reducing injection pain as 40 mg of lidocaine. 7 In contrast, pretreating with 100 mg thiopentone was more effective than 20 mg of lidocaine. 8 In children, pretreatment with 3 mg·kg -1 of thiopentone prior to injecting propofol 1.5 mg·kg -1 with lidocaine 0.075 mg·kg -1 reduced the injection pain from 81% to 27%.…”

Comparative Study Between Thiopental and Lidocaine for Prevention of Pain Associated With Propofol Injection

“…Nevertheless, the sedative effect of such a large dose of thiopental on perception of pain by visual analogue scale cannot be eliminated. Haugen et al (14) compared the efficacy of thiopental 50 mg. (approx. 0.8 mg/kg) pretreatment with lidocaine 40 mg and observed that thiopental only reduced the severity of propofol pain whereas lidocaine reduced both the incidence and severity of pain.…”