Effect of pretreatment with ketorolac on propofol injection pain

BACKGROUND: : Pain on injection is still a major problem with propofol. We performed this study to compare different doses of intravenous (i.v.) ketorolac with and without venous occlusion and its effect on the incidence and the severity of the pain after propofol injection. METHODS: We conducted a prospective, randomized and double-blind study of 180 patients (20-60 years of age.) scheduled to undergo elective surgery. Six groups of patients were generated: group A received normal saline (NS) 2 ml i.v.; groups B, C, D received ketorolac 10 mg in 2 ml NS with venous occlusion (VO) and a subsequent propofol injection at either 30, 60 or 120 s; groups E and F received ketorolac 15 mg and 30 mg in 2 ml NS and propofol was injected after 60 s. The pain perception was assessed during injection of propofol in all patients. RESULT: : The incidence of propofol-associated injection pain was for A: 46.7%; B: 43.4%; C: 23.3%; D:16.7%; E: 20%, and F: 10%. The incidence of pain following propofol injection was reduced by i.v. ketorolac 10 mg with venous occlusion for 120 s. Furthermore, i.v. ketorolac 15 mg and 30 mg but not 10 mg following propofol injection after 60 s without venous occlusion revealed significant pain reduction when compared to saline group. There was no difference in venous sequelae at 7 days postoperatively between the groups. CONCLUSION: Our results suggested that pretreatment with i.v. 15 and 30 mg ketorolac reduces pain following propofol injection. Moreover, pretreatment with i.v. ketorolac 10 mg with venous occlusion for 120 s achieves the same pain relief effect.     

Pretreatment with thiopental for prevention of pain associated with propofol injection

Propofol causes pain on IV injection in 28%-90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status I-II, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P < 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection. IMPLICATIONS: Pain associated with IV injection of propofol is seen in 28%-90% patients. Pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg after manual venous occlusion for 1 min effectively attenuated pain associated with propofol injection. Thiopental 0.5 mg/kg was the most effective in prevention of propofol pain and can be used routinely.     

Sustained intravascular exposure to propofol does not prolong pain at the site of injection

BACKGROUND: Pain at the site of intravenous injection of propofol is a common clinical finding. This double-blind, randomized cross-over study was designed to evaluate whether venous occlusion applied during injection of a low dose of propofol reduces the intensity of pain at the site of injection compared with no occlusion. METHODS: Bilateral 0.5-ml injections of an emulsion containing 10 mg/ml of propofol were given over 30 s in 75 adult surgical patients. Each patient was given one injection with and one without 60-s occlusion of the cannulated vein with a 10-min interval, and asked to score the maximal pain intensity on a visual analogue scale (VAS). RESULTS: The maximal pain intensity [median (25th percentile; 75th percentile), range] at the site of injection was 0.5 (0; 3.5), 0-8.0 VAS units with venous occlusion and 0.5 (0; 1.4), 0-6.0 VAS units without occlusion (P= 0.042). Pain was first reported within 20 s regardless of the study regimen and was not prolonged by local venous occlusion. CONCLUSION: Venous occlusion augments pain intensity at the site of propofol injection without prolonging pain, implying that propofol-induced pain is determined more by the blood concentration than by the duration of intravascular exposure. The low intensity of pain induced by low-dose propofol and the fading of pain despite sustained exposure suggest that initial low-dose administration of propofol should be evaluated for the attenuation of local pain induced by higher intravenous doses of propofol.     

Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified

PURPOSE: Propofol produces anesthesia with rapid recovery. However, it causes pain or discomfort on injection. A number of techniques have been tried for minimizing propofol-induced pain with variable results. We have compared the efficacy of magnesium and lidocaine for the prevention of propofol induced pain. METHODS: Three hundred ASA I and II adults undergoing elective surgery were randomly assigned into three groups of 100 each. Group I received magnesium sulfate 1 g, Group II received lidocaine 2% (40 mg) and Group III received normal saline, all in a volume of 2 mL and accompanied by venous occlusion for one minute. Induction with propofol 2.5 mg.kg(-1) was accomplished following the release of venous occlusion. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of pretreatment and propofol injection. Results were analyzed by 'Z' test. A P value of < 0.05 was considered as significant. RESULTS: Pain during i.v. pretreatment with magnesium was 31% as compared to 2% for both the lidocaine and control groups (P < 0.05). Seventy-six percent of patients in the control group had pain during i.v. propofol as compared to 32% and 42% in the magnesium and the lidocaine groups respectively (P < 0.05). Lidocaine and magnesium pretreatment were equally effective in attenuating pain during the propofol injection (P > 0.05). CONCLUSIONS: Intravenous magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain. However, magnesium pretreatment itself causes pain. Therefore, there is no justification in the use of magnesium pretreatment for attenuating pain associated with i.v. propofol.     

Comparison of diphenhydramine and lidocaine for prevention of pain after injection of propofol: a double-blind, placebo-controlled, randomized study

BACKGROUND AND OBJECTIVE: Pain on injection is still a problem with propofol. The purpose of the study was to compare the effectiveness of diphenhydramine and lidocaine on pain caused by propofol at the site of injection. METHODS: One hundred and eighty ASA I-II adults undergoing elective surgery were randomly assigned into three groups of 60 each. Group I (placebo) received 2 mL normal saline, Group II received 2 mL (40 mg) 2% lidocaine and Group III received 2 mL (20 mg) diphenhydramine intravenously (i.v.) during a 1-min venous occlusion, followed by propofol into a cephalic forearm vein of the antecubital fossa. Pain assessment was made immediately after propofol injection. RESULTS: In the placebo group 25 (41.7%) patients experienced pain during propofol injection as compared to 2 (3.3%) and 3 (5.0%) in the lidocaine and diphenhydramine groups, respectively. The prevalence of pain and pain score were significantly less in both the lidocaine and diphenhydramine groups than in the placebo group (P = 0.00). No difference was found between the diphenhydramine and lidocaine groups (P = 0.60). CONCLUSION: Previous injection of diphenhydramine with venous occlusion can be considered as an alternative to lidocaine for reducing the prevalence of pain caused by injection of propofol into peripheral veins.     

The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine.

BACKGROUND AND OBJECTIVES: Tramadol and metoclopramide have a local anesthetic effect similar to lidocaine following intradermal injection. When metoclopramide was retained in the venous system for 1 minute, it was found to be as effective as lidocaine in reducing propofol injection pain. Using this metoclopramide model, the effects of tramadol in reducing pain on propofol injection was investigated. METHODS: One hundred five patients were randomly allocated to receive 50 mg tramadol (group T), 60 mg lidocaine (group L), or normal saline (group NS) as pretreatment to reduce pain on propofol injection. Following venous occlusion with a tourniquet (70 mm Hg), one of the drugs was intravenously administered. Venous retention of the drug was maintained for 1 minute. Immediately after the tourniquet release, intravenous injection of 100 mg propofol (10 mL) at a rate of 0.5 mL/s followed. Pain assessment was made after each injection. RESULTS: Transient minor injection pain and local skin reactions were significantly greater with tramadol than with lidocaine (P < .05). Both tramadol and lidocaine significantly reduced the incidence and intensity of propofol injection pain when compared with normal saline (P < .05). CONCLUSIONS: Using -minute retention in veins, both tramadol and lidocaine significantly reduced propofol injection pain. A local anesthetic activity is postulated.     

Prilocaine reduces injection pain caused by propofol

Propofol, which is commonly used for outpatient anaesthesia, may evoke pain during infusion. Forty-eight patients (ASA I-II) undergoing elective uterine dilatation and curettage received randomly in a standardised fashion: A: Propofol mixed with prilocaine; B: Propofol and lidocaine; C: Propofol with prilocaine + lidocaine (equal amounts) or D: Propofol and saline. The final ratio of propofol: local anaesthetic/saline was 9: 1 in all mixtures. Pain on injection was significantly decreased in the three groups receiving propofol and local anaesthetic(s) compared to the one given propofol and saline. Propofol is required in greater amounts when mixed with lidocaine than when mixed with saline. A binding between the algesic part of the propofol molecule and the local anaesthetic agent may explain these findings. Another twenty-two comparable patients were given 30 mg of ketorolac or an equal volume of saline intramuscularly 45 60 minutes prior to propofol. Ketorolac given before propofol did not reduce pain on injection. This indicates that inhibition of the cyclooxygenase pathway of arachidonic acid metabolism does not play a major role in the reduction of this pain.     

Painless injection of propofol: pretreatment with ketamine vs thiopental, meperidine, and lidocaine

Propofol, a commonly used anesthetic, often causes pain on injection. Several methods have been described to reduce this pain, however, complete inhibition has not been achieved. Our randomized, placebo controlled, double blind study has been conducted to compare the analgesic efficacy of iv pretreatment of ketamine, meperidine, thiopental, lidocaine to minimize the injection pain of propofol. 125 patients ASA I and II were randomly allocated into 5 groups and received. Group K, ketamine 0.4 mg/kg; Group T, thiopental 0.5 mg/kg; Group M, meperidine 0.5 [corrected] mg/kg; Group L, lidocaine 1 mg/kg; Group S, saline 3 ml. All pretreatment drugs were made into 4 ml solutions and were accompanied by manual venous occlusion for 1 min, followed by tourniquet release and slowly IV administration of propofol. Pain was assessed with a four point scale. All treatment groups had a significantly lower incidence of pain than placebo group (p <0.05). However, it has been observed that pretreatment with ketamine was the most effective in attenuating pain associated with propofol injection (p <0.05). For painless injection of propofol, routine pretreatment with ketamine 0.4 mg/kg along with venous occlusion is recommended.     

The effects of alfentanil or remifentanil pretreatment on propofol injection pain

STUDY OBJECTIVE: To compare the efficacy of alfentanil, remifentanil, and saline in minimizing the propofol injection pain. DESIGN: Randomized, double-blind study. SETTING: University hospital. PATIENTS: 175 ASA physical status I and II, adult female patients undergoing minor gynecological procedures with general anesthesia. INTERVENTIONS: Unpremedicated patients were randomly allocated to one of four groups. Patients received 2 mL (1 mg) of alfentanil (n=43), 2 mL of remifentanil 0.01 mg (n = 43), 2 mL of remifentanil 0.02 mg (n=45), or 2 mL of saline (n=44) 30 seconds prior to administration 5 mL of propofol 1%. MEASUREMENTS: Patients were asked whether they had pain due to propofol injection. Their pain scores were evaluated with a Visual Analogue Scale. In the Postanesthesia Care Unit, frequency of postoperative nausea, vomiting, hypotension, and flushing were all determined. MAIN RESULT: The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than the saline group (p <0.05). When the alfentanil group was compared with the remifentanil groups, significant differences in pain relief associated with injection of propofol (p <0.001) were noted. Remifentanil 0.02 mg relieved pain associated with injection of propofol more effectively than remifentanil 0.01 mg (p <0.001). CONCLUSIONS: The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than did the saline group. Remifentanil was effective in preventing propofol injection pain, and should be used at a dose of at least 0.02 mg for this purpose. Remifentanil may be an alternative drug for prevention of propofol injection pain.     

Pain on injection of propofol Methods of alleviation

A controlled randomised double-blind design was used to study the effect of lignocaine on the pain produced by intravenous injection of propofol. Patients received a 2-ml pretreatment solution with temporary venous occlusion, followed by an induction solution. One hundred and three patients were assigned to one of five groups: saline pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 20 mg pretreatment, followed by induction with propofol plus saline 2 ml; lignocaine 40 mg pretreatment, followed by induction with propofol plus saline 2 ml; saline pretreatment, followed by induction with propofol plus lignocaine 20 mg; or saline pretreatment, followed by induction with propofol plus lignocaine 40 mg. Pain was reduced significantly in all groups in which lignocaine was used and a dose of 40 mg was more effective than 20 mg. There were no significant differences in the incidence of pain among the groups which received lignocaine as pretreatment and the groups which received lignocaine mixed with propofol. Sixty-eight percent of patients who experienced pain or discomfort recalled it in the postoperative period.     

Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain

BACKGROUND: Different methods and propofol formulations have been used to decrease propofol injection pain, but it remains an unresolved problem. We aimed to investigate the effect of i.v. acetaminophen pretreatment on the propofol injection pain. METHODS: One hundred and fifty ASA I-II patients undergoing general anaesthesia were randomly allocated into three groups. A 20-gauge catheter was inserted into a superficial radial vein of the left hand, and after the occlusion of venous drainage, Groups I, II, and III were pretreated with 40 mg of lidocaine in saline, 50 mg of i.v. acetaminophen, and 5 ml of saline, respectively. The occlusion was released after 2 min and one-fourth of the total propofol dose was injected into the vein over a period of 5 s. During the injection of both pretreatment solution and propofol, patients' pain was assessed and recorded as 0-3, corresponding to no, mild, moderate or severe pain, respectively. Chi2 and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P<0.05. RESULTS: Patient characteristics were similar among the groups. Incidence of pain on injection of propofol in control, i.v. acetaminophen, and lidocaine groups was 64%, 22% and 8%, respectively (P<0.05). CONCLUSIONS: Pretreatment with i.v. acetaminophen seems to be effective in attenuating pain during i.v. injection of propofol.     

Effect of parecoxib pretreatment and venous occlusion on propofol injection pain: a prospective,randomized, double-blinded,placebo-controlled study

Study ObjectiveTo investigate the effect of parecoxib pretreatment with venous occlusion on propofol injection pain.DesignProspective, randomized, double-blinded, placebo-controlled study.SettingOperating room of a tertiary-care medical center.Patients150 ASA physical status I patients scheduled for elective surgery.InterventionsPatients were randomized to three groups of 50 patients each to receive pretreatment with normal saline (Group NS), parecoxib 20 mg (Group P20), or parecoxib 40 mg (Group P40). All groups underwent venous occlusion for two minutes before propofol was injected. All pretreatment drugs were prepared in 5 mL doses.MeasurementsPain scores were obtained by a study-blinded observer during propofol injection following the different pretreatment solutions.Main ResultsPain scores among the three groups were significantly different (P ≤ 0.001). In Group NS, 29 (58%) patients had pain during propofol injection compared with 22 (40%) Group P20 and 13 (26%) Group P40 patients (P ≤ 0.005). Pain was significantly reduced in Group P40 (P ≤ 0.001) compared with the control group. Moderate to severe pain was experienced by 18 (36%) Group NS and 4 (8%) Group P20 patients, whereas no Group P40 patient experienced moderate or severe pain (P < 0.001). Reduction in pain severity was statistically significant after pretreatment with either parecoxib 20 mg (P = 0.002) or parecoxib 40 mg (P < 0.001).ConclusionParecoxib 40 mg with venous occlusion is effective in reducing the frequency and severity of pain with propofol injection. Pretreatment with 20 mg of parecoxib reduces the severity of propofol injection pain significantly but does not reduce frequency compared with the control group.     

Influence of aging on lidocaine requirements for pain on injection of propofol

STUDY OBJECTIVE: To evaluate the influence of aging on lidocaine requirements for propofol-induced pain on injection. DESIGN: Prospective, randomized, double-blind, placebo-controlled study. SETTING: The study was undertaken at a University hospital. PATIENTS: 160 ASA physical status I and II adult patients scheduled for elective surgery with general anesthesia. INTERVENTIONS: Patients received placebo (saline) or lidocaine intravenously at three different doses (10, 20, or 40 mg), with venous occlusion for two minutes, followed by injection of propofol 0.5 mg/kg into a dorsal hand vein. MEASUREMENT AND MAIN RESULTS: Pain during injection of propofol was evaluated. For young patients, the frequency of propofol-induced pain was 70% in patients receiving lidocaine 10 mg (P = not significant); 50% in those receiving lidocaine 20 mg (P = not significant); and 30% in those receiving lidocaine 40 mg (P < 0.05), compared with placebo (80%). For elderly patients, 15 patients (75%) complained of pain in the placebo group, compared with 13 (65%) in the lidocaine 10 mg group (P = not significant); 5 (25%) in the lidocaine 20 mg group (P < 0.05); and 4 (20%) in the lidocaine 40 mg group (P < 0.05). CONCLUSIONS: A lidocaine dose of 40 mg for young patients and 20 mg for old patients, with venous occlusion for two minutes, is sufficient to reduce pain on injection of propofol.     

Preventing pain on injection of propofol: a comparison between lignocaine pre-treatment and lignocaine added to propofol

A randomized double-blind study compared two methods of preventing the pain from injection of propofol, lignocaine pre-treatment followed by propofol and lignocaine added to propofol. One hundred patients received a 4 ml solution intravenously with a venous tourniquet for 1 minute, followed by propofol mixed with 2 ml of solution. Patients were divided into two treatment groups of 50 patients each: 4 ml 1% lignocaine pre-treatment followed by propofol and 2 ml saline, or 4 ml saline followed by propofol and 2 ml 2% lignocaine. Pain was assessed with a 100 mm visual analogue scale after induction and in recovery. The incidence of injection pain was 8% in the propofol mixed with lignocaine group, and 28% in the lignocaine pre-treatment group. This difference is statistically significant (P=0.017). For those patients who had pain, the mean pain score was 26.5 on induction for the propofol with lignocaine group (n =4), while the mean score was 44.4 for the pre-treatment group (n=13). The difference was not statistically significant (P=0.25). None of the propofol mixed with lignocaine group recalled pain, while 13 of the pre-treatment group did so. Lignocaine pre-treatment does not improve the immediate or the recalled comfort of patients during propofol induction when compared to lignocaine added to propofol. It is recommended that lignocaine should be added to propofol for induction rather than given before induction.     

A lidocaine/metoclopramide combination decreases pain on injection of propofol

PURPOSE: Injection pain is a well-known adverse effect of propofol which distresses patients. Lidocaine pretreatment is the most popular method for reducing this pain but this drug cannot entirely eliminate the problem. The purpose of this study was to examine the analgesic effect of lidocaine/metoclopramide combination, compared with lidocaine alone, during propofol injection. METHODS: In a randomized, double-blind, placebo-controlled trial, 90 patients, 40 males and 50 females, scheduled for elective plastic surgery received either lidocaine 20 mg plus metoclopramide 10 mg iv, lidocaine 20 mg iv, or placebo (saline); (n = 30 in each), with venous occlusion for one minute, followed by administration of propofol 0.5 mg.kg(-1) into a dorsal hand vein. Pain was assessed on a four-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe) during propofol injection. RESULTS: 25 patients (83%) complained of pain in the placebo group, compared with 12 (40%) in the lidocaine group (P < 0.05) and three (10%) in the combination group (P < 0.05). Pain score (median) was less in the lidocaine (0) and combination (0) groups than in the placebo group (2); (P < 0.05). The difference in the incidence of pain between the combination and lidocaine groups was significant (P < 0.05). CONCLUSION: A lidocaine/metoclopramide combination is more effective than lidocaine alone for reducing pain on injection of propofol in a peripheral vein.     

Comparison of Propofol-Lipuro with propofol mixed with lidocaine 10 mg on propofol injection pain

A common drawback of propofol is pain on injection and lidocaine is commonly mixed with propofol to reduce its incidence and severity. We conducted a randomised, prospective, double-blind study to compare injection pain following the administration of two different formulations of propofol in 200 unpremedicated ASA I-III adult patients scheduled for elective surgery under general anaesthesia. Patients were allocated randomly into two groups to receive either Propofol-Lipuro without added lidocaine or Diprivan mixed with lidocaine 10 mg. Five ml of the study solution was injected at a constant rate over 15 s and patients graded any associated pain or discomfort using a four-point verbal rating scale. The incidence of propofol injection pain was virtually identical in both study groups with 37/98 (38%) patients experiencing pain or discomfort following Propofol-Lipuro compared with 35/98 (36%) after Diprivan (p = 0.88). We observed no significant difference in pain scores between the groups (p = 0.67). Moderate or severe injection pain was experienced by 12/98 (12%) patients given Propofol-Lipuro compared with 8/98 (8%) given Diprivan (p = 0.48).     

Induction of anesthesia with propofol injected through a central venous catheter

We compared propofol injected through a central venous catheter with that through a peripheral cannula from the standpoint of injection pain, induction time and hemodynamic changes. Thirty-nine patients about to receive abdominal surgery, who had central venous catheters inserted via the subclavian vein, were included in this study. General anesthesia was induced with a loading dose of propofol 1 mg.kg-1 followed by an infusion of 10 mg.kg-1.hr-1 into the central vein without carrier intravenous fluid (group A, n = 13), the peripheral vein without carrier intravenous fluid (group B, n = 13) or the peripheral vein with rapid infusion of acetated Ringer's solution (group C, n = 13). After endotracheal intubation, anesthesia was maintained with propofol 4 mg.kg-1.hr-1. The incidence of injection pain was 53% in group B and 76% in group C, whereas none of the patients in group A felt discomfort or pain during propofol injection. The mean induction time was significantly shorter in group A (43 +/- 12 sec) than group B (66 +/- 16 sec) or group C (57 +/- 11 sec). There were no differences between each group in hemodynamic changes during induction of anesthesia. Propofol injection via central venous catheter can avoid the injection pain and shorten the induction time.     

Effect of metoclopramide on pain on injection of propofol

We undertook a randomized, double-blind, placebo-controlled study to examine the efficacy of metoclopramide at three different doses (2.5 mg, 5 mg, 10 mg) for reducing pain on injection of propofol in 100 patients scheduled for elective surgery. Patients received intravenously the study drug, with venous occlusion for one minute, followed by propofol 2 mg/kg into a dorsal hand vein. The incidence of pain was significantly less in patients receiving metoclopramide 5 mg (32%) or 10 mg (28%) than in patients receiving placebo (80%) (P<0.01). No difference between metoclopramide 2.5 mg and the placebo groups was found. We conclude that pretreatment of a dorsal hand vein with metoclopramide in a dose of 5 or 10 mg, with venous occlusion for one minute, effectively decreases the incidence of pain caused by propofol injection.     

Prevention of propofol injection pain,using lidocaine in a large volume does it make a difference? A prospective randomized controlled double blinded study

PurposePropofol has become one of the most common anesthetic agents used for anesthesia because of its unique pharmacologic properties. Pain during bolus injection is a major drawback of propofol. The target of this study was to study the effect of lidocaine used in a large volume on prevention of propofol injection pain. Our hypothesis is that IV administration of diluted lidocaine in a large volume before propofol injection could be more effective in prevention of both immediate and delayed types of pain associated with propofol injection than the most commonly used method of mixing lidocaine with propofol (30 mg lidocaine/added to the 20 ml propofol syringe).Methods100 Patients with age range (20–60) years and classified ASA1 and ASA2 undergoing general anesthesia for elective surgery were included in this study. Patients were classified into two groups, the first (study) group, in which 30 mg lidocaine diluted into a total volume of 20 ml using normal saline was given IV after venous occlusion with rubber tourniquet followed by propofol injection. In the second (control) group, 30 mg lidocaine was mixed with propofol and given to the patient as commonly used.ResultsThis study showed a highly significant reduction in the propofol injection pain in the study group compared to the control group.Conclusionlidocaine when given diluted in a large volume after venous occlusion has dramatically reduced propofol injection pain in adults.     

Effect of diclofenac pretreatment on pain during propofol injection

In a randomized, double-blind, controlled trial, 120 ASA 1 or 2 patients were allocated to receive diclofenac or normal saline as pretreatment to assess their effect on incidence and severity of pain during propofol injection. Diclofenac in two different doses, i.e. 25 mg and 15 mg, was tried for this purpose. The overall incidence of pain did not significantly differ among the groups, but the incidence of moderate to severe pain following propofol injection was significantly less in patients who received diclofenac 25 mg (P = 0.0017) or 15 mg (P = 0.0363) than in those who received saline. However, the diclofenac itself was associated with mild pain in some patients.