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Reduction of pain on injection of propofol: combination of pretreatment of remifentanil and premixture of lidocaine with propofol

Published online by Cambridge University Press:  01 September 2007

K. Kwak ,
J. Kim ,
S. Park ,
D. Lim ,
S. Kim ,
W. Baek  and
Y. Jeon
K. Kwak
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
J. Kim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
S. Park
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
D. Lim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
S. Kim
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
W. Baek
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
Y. Jeon*
Affiliation:
Kyungpook National University, School of Medicine, Department of Anesthesiology, Daegu, South Korea
*
Correspondence to: Younghoon Jeon, Department of Anesthesiology, School of Medicine, Kyungpook National University, 50 Samduck 2ga, Jung gu, Daegu 700-721, South Korea. E-mail: [email protected]; Tel: +82 53 420 5871; Fax: +82 53 426 2760
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Summary

Backgrounds and objective

There is a high incidence of pain following intravenous injection of propofol, and many studies have been conducted to find a way of reducing this. The administration of lidocaine and, recently, remifentanil has also been used for this purpose, but it is only partially effective. Thus, the purpose of this study was to investigate the analgesic effect of a combination of pretreatment with remifentanil and premixture of lidocaine with propofol and to compare either treatment alone during propofol injection in dorsal hand-veins.

Methods

In a prospective, randomized, double-blinded trial, we studied 141 adult patients scheduled for elective surgery. The combination of pretreatment of remifentanil (0.35 μg kg−1 min−1) and a premixture of lidocaine with propofol (mixture of propofol 1% and lidocaine 1% in a 10 : 1 ratio) was compared with either treatment alone in the prevention of pain on propofol injection. Pain was assessed on a four-point scale (0 = none, 1 = mild, 2 = moderate, 3 = severe) during propofol injection. Patients in Group B received remifentanil (0.35 μg kg−1 min−1) 30 s before the injection of propofol.

Results

The reduction of pain on propofol injection was similar in both the remifentanil pretreatment and lidocaine premixture groups (62.2% vs. 62.2%). Combination therapy was associated with a higher incidence of patients without pain (91.3%) than either treatment alone (P < 0.001). On analysing the injection pain scores, we found a significant reduction of the score in the remifentanil and lidocaine Group C compared with the lidocaine Group A (P < 0.001) and the remifentanil Group B (P < 0.001).

Conclusions

The combination of pretreatment of remifentanil and premixture of lidocaine with propofol was more effective in reducing the incidence of pain on injection of propofol than either treatment alone.

Keywords

ANAESTHETICS INTRAVENOUSPROPOFOLLIDOCAINEADVERSE EFFECTSANALGESICS OPIOID, remifentanil
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 9 , September 2007 , pp. 746 - 750
Copyright
Copyright © European Society of Anaesthesiology 2007

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