Pain on injection of propofol. A comparison of cold propofol with propofol premixed with lignocaine

Propofol is frequently associated with pain on injection. Previous studies have suggested that chilling of the propofol decreases pain significantly. This prospective, randomised, double-blind trial was designed to assess the effectiveness of cold propofol compared with propofol premixed with lignocaine in minimising pain on injection. Patients were allocated to one of four groups: propofol + lignocaine 0.1 mg.kg⁻¹, propofol + lignocaine 0.2 mg.kg⁻¹, cold propofol and a control group consisting of propofol premixed with normal saline and maintained at room temperature. The results of this study show that cold propofol is associated with a very high incidence of injection pain while lignocaine 0.1 mg.kg⁻¹ premixed with propofol significantly decreases the incidence of pain (p < 0.001). Increasing the dosage of lignocaine above 0.1 mg.kg⁻¹, however, does not significantly decrease the incidence of pain further. The addition of lignocaine also significantly decreases the incidence of excitatory side-effects.     

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).     

Pain on injection with propofol

Injection-induced pain during induction of anaesthesia can result in patient's discomfort. This can prevent the use of propofol-anaesthesia in paediatric patients. Because of the high incidence of pain on injection with propofol numerous interventions have been tested to prevent this pain including the use of different drugs and physical measures as well as the combination of methods. The use of a single intervention is not as effective as the combination of different preventive measures. Thus the additional application of a venous tourniquet improves the pain reducing effect if drugs with peripheral mechanism of action are used for prevention of pain. Injection of lidocaine with a rubber tourniquet before the propofol injection is recommended as best effective method. In any case a propofol-MCT/LCT-Emulsion should be used for propofol-anaesthesia. Additionally a multimodal strategy that is adapted to the daily clinical practice seems to be convenient. That means, for general anaesthesia opioids or ketamine and for sedation a sub-anaesthetic dose of thiopental can be used for effective prevention of pain. If the prevention of nausea and emesis is intended, antiemetics that are appropriate for prevention of injection pain should be given. For paediatric anaesthesia the application of EMLA-cream seems to be suitable, because it alleviates the pain during venous cannulation at the same time. Although a painfree propofol injection is not possible with every prevention strategy there exist a wide range of effective interventions to prevent pain on injection with propofol. This article reviews methods that have been investigated and established to minimise the incidence of pain.     

Effect of pre-mixed lidocaine with propofol on propofol injection pain in elderly patients

The purpose of this study was to compare the younger and older patients in the incidence and the severity of the pain during injection of propofol. Thirty-four, elderly patients (60-80-yr-old) and 52 patients (20-40-yr-old) scheduled to undergo elective surgery were studied. We conducted a prospective, randomized and double-blinded trial. All patients were randomly allocated to one of two groups according to the agents added to 1% propofol 20 ml; Group S, normal saline 2 ml, and Group L, 2% lidocaine 2 ml. The pain on injection was rated as none, mild, moderate, or severe. Seventy percent of patients in the S group of elderly patients experienced pain, while 22% of patients experienced pain in the L group in elderly patients. The incidence of pain on injection in the S group of older patients was comparable with S group of younger patients. The severity of pain in elderly patients was significantly decreased after premixing with lidocaine. There were no significant differences between older and younger patients in the severity of propofol injection pain in both S group and L group. In conclusion, elderly patients suffered the pain on injection of propofol with the same incidence as the younger patients did. Lidocaine premixed with propofol significantly reduces the incidence and the severity of pain associated with propofol in elderly patients.     

口腔颌面外科手术中舒芬太尼复合丙泊酚与芬太尼复合丙泊酚麻醉效果的比较

目的:探讨了舒芬太尼或芬太尼复合丙泊酚对口腔颌面外科手术血流动力学和应激反应的影响。方法:我院于2006年1月～2011年1月共收治口腔颌面外科手术患者240例,按照随机分组法随机分为舒芬太尼复合丙泊酚组(S组)和芬太尼复合丙泊酚组(F组)。分别记录两组患者不同时期舒张压(DBP)、收缩压(SBP)、心率(HR)、去甲肾上腺素(NE)、皮质醇(Cor)和血糖(Glu)的变化。结果:与T0时比较,两组患者T1、T2、T3和T4时DBP、SBP、HR、NE、Cor和Glu均有一定程度的升高,而F组变化具有显著统计学意义(P<0.05)。F组T1、T2、T3和T4时DBP、SBP、HR、NE、Cor和Glu均较S组高,差异具有统计学意义(P<0.05)。结论:舒芬太尼符合丙泊酚用于口腔颌面外科手术时血液动力学较为稳定,机体应激反应弱,值得临床使用。     

口腔颌面外科手术中舒芬太尼复合丙泊酚与芬太尼复合丙泊酚麻醉效果的比较

目的:探讨了舒芬太尼或芬太尼复合丙泊酚对口腔颌面外科手术血流动力学和应激反应的影响。方法:我院于2006年1月～2011年1月共收治口腔颌面外科手术患者240例,按照随机分组法随机分为舒芬太尼复合丙泊酚组(S组)和芬太尼复合丙泊酚组(F组)。分别记录两组患者不同时期舒张压(DBP)、收缩压(SBP)、心率(HR)、去甲肾上腺素(NE)、皮质醇(Cor)和血糖(Glu)的变化。结果:与T0时比较,两组患者T1、T2、T3和T4时DBP、SBP、HR、NE、Cor和Glu均有一定程度的升高,而F组变化具有显著统计学意义(P<0.05)。F组T1、T2、T3和T4时DBP、SBP、HR、NE、Cor和Gl u均较S组高,差异具有统计学意义(P<0.05)。结论:舒芬太尼符合丙泊酚用于口腔颌面外科手术时血液动力学较为稳定,机体应激反应弱,值得临床使用。     

Intubation with propofol augmented with intravenous lignocaine

Sixty patients of ASA grade 1 and aged 18 to 55 years were admitted to a double-blind study. Anaesthesia was induced with propofol 2.5 mg/kg after intravenous pretreatment with lignocaine 1.5 mg/kg or a similar volume of isotonic saline. The quality of subsequent tracheal intubation was graded and the pressor response to tracheal intubation assessed. There were no significant differences between treatment groups.     

Total intravenous anesthesia with propofol vs. propofol/N2O anesthesia

The authors have compared two groups of 31 patients each, undergone an anaesthesia with propofol-O2/N2O (group I) and propofol-O2/air (group II). The average anaesthetic dosage and the neuromuscular recovery time have been valued, keeping constant the dose of analgesic. The average consumption of propofol (except the inductive dose of 2 mg/kg) was 7.41 +/- 1.71 mg/kg/h in group I, and 7.47 +/- 1.76 in group II (p = 0.88; not significant) and the neuromuscular recovery time 56.12 +/- 34.55 m' and 49.48 +/- 40.50 m' respectively (p = 0.53; not significant). The cardiocirculatory parameters have been compared at the time of induction, surgical incision and for all the operation time, reporting every undesired effect. The awakening has been monitored until 15 m' from the interruption of propofol infusion. The data obtained don't permit to observe significant differences with regard to analgesia, neuromuscular block and awakening time. Therefore the authors put the question of the real necessity to use nitrous oxide, when it has utilized an efficient intravenous anaesthetic as the propofol has proved to be.     

Target-controlled infusion with propofol for neuro-anesthesia

Propofol is an intravenous anaesthetic agent, which presents interesting features for its use in neuro-anaesthesia: it is a powerful hypnotic that does not increase the intracranial pressure. The delay of recovery is short even after several hours of continuous infusion. This is essential for a fast neurologic examination. Continuous infusion should be preferred to bolus in order to prevent hypotension and decrease of the cerebral perfusion pressure. Target-controlled infusion models based on effect site concentrations are now available through several softwares. This technique appears especially useful for awake craniotomy and functional neurosurgery. The level of consciousness is easily fixed between deep anaesthesia and light sedation permitting to ask the patient to move following orders. A sedation controlled by the patient himself is even possible.     

Manual compared with target-controlled infusion of propofol

We studied 160 ASA I-II patients, anaesthetized with propofol by infusion, using either a manually controlled or target-controlled infusion system. Patients were anaesthetized by eight consultant anaesthetists who had little or no previous experience of the use of propofol by infusion. In addition to propofol, patients received temazepam premedication, a single dose of fentanyl and 67% nitrous oxide in oxygen. Each consultant anaesthetized 10 patients in sequential fashion with each system. Use of the target-controlled infusion resulted in more rapid induction of anaesthesia and allowed earlier insertion of a laryngeal mask airway. There was a tendency towards less movement in response to the initial surgical stimulus and significantly less movement during the remainder of surgery. Significantly more propofol was administered during both induction and maintenance of anaesthesia with the target-controlled system. This was associated with significantly increased end-tidal carbon dioxide measurements during the middle period of maintenance only, but recovery from anaesthesia was not significantly prolonged in the target- controlled group. With the exception of a clinically insignificant difference in heart rate, haemodynamic variables were similar in the two groups. Six of the eight anaesthetists found the target-controlled system easier to use, and seven would use the target-controlled system in preference to a manually controlled infusion. Anaesthetists without prior experience of propofol infusion anaesthesia quickly became familiar with both manual and target-controlled techniques, and expressed a clear preference for the target-controlled system.      

Diabetes insipidus associated with propofol anesthesia

Diabetes insipidus is a clinical entity that is often seen in neurosurgical patients either during or immediately after transsphenoidal hypophysectomy. Rarely, diabetes insipidus can manifest as a new entity months later in patients who have previously had an intracranial injury or operation.     

Myocardial preservation with propofol is dose-dependent

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -