A comparison of pain on intravenous injection to two formulations of Propofol, one containing medium chain and long chain triglycerides and the other without medium chain and long chain triglycerides
DOI:
https://doi.org/10.18203/2320-6012.ijrms20195509Keywords:
Injection pain, Medium chain and long chain triglycerides, Propofol, Visual Analog ScaleAbstract
Background: To assess and compare the Visual Analog Scale (VAS) for pain on intravenous injection in patients receiving the two different formulations of Propofol.
Methods: Total 170 eligible patients were randomized into Group A receiving Propofol MCT/LCT and Group B receiving Propofol LCT. After standard pre-anaesthetic preparation and baseline values recording, the blinded investigator recorded pain intensity after injection of 1mL study drug propofol, using Visual Analog Scale (0-10). Haemodynamic parameters were recorded every minute for 5 minutes. Calculated Propofol dose was injected in 20 seconds, and signs of pain (hand withdrawal, grimacing) were noted. After patient regained full consciousness, recall of injection pain was asked for.
Results: The proportion of patients who experienced pain was similar in both groups (group A: 76/85 =89.41%, group B: 81/85 = 95.29%; statistically not significant (p value=0.247). Patients in group A had longer time for pain onset (11.3 seconds-group A Vs 9.8 seconds-group B; statistically significant, p value =0.008). Pain on injection was higher in Propofol LCT group as compared to Propofol MCT/LCT (VAS scores of group A=3.94±2.0 vs group B = 5.49±1.96; statistically significant; p value = 0.0018). Full dose of Propofol MCT/LCT produced significantly less pain when compared to Propofol LCT (p value = 0.0424). Recall of pain was comparable between the groups. Haemodynamic parameters (Heart rate and Mean Arterial Pressure) remained comparable in both groups.
Conclusions: Pain on injection was higher and statistically significant in Propofol LCT group as compared to Propofol MCT/LCT.
References
Wang W, Wu L, Zhang C, Sun L. Is propofol injection pain really important to patients?. BMC Anesthesiol. 2017;17(1):24.
Doenicke AW, Roizen MF, Rau J, Kellermann W, Babl J. Reducing pain during propofol injection: the role of the solvent. Anesth Anal. 1996;82(3):472-4.
Kang HJ, Kwon MY, Choi BM, Koo MS, Jang YJ, Lee MA. Clinical factors affecting the pain on injection of propofol. Kor J Anesthesiol. 2010;58(3):239.
Hwang I, Noh JI, Im Kim S, Kim MG, Park SY, Kim SH, et al. Prevention of pain with the injection of microemulsion propofol: a comparison of a combination of lidocaine and ketamine with lidocaine or ketamine alone. Korean J Anesthesiol. 2010;59(4):233.
Kaya S, Turhanoglu S, Karaman H, Özgün S, Basak N. Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults. Curr Therap Res. 2008;69(1):29-35.
Aggarwal S, Kumar M, Sharma V. A single-centre randomized-controlled trial to study effect of dilution on propofol-induced injection pain at injection site. Saudi J Anaesth. 2011;5(3):282.
Uda R, Kadono N, Otsuka M, Shimizu S, Mori H. Strict temperature control has no effect on injection pain with propofol. Anesthesiol. 1999;91(2):591.
Byon HJ, Lee KW, Shim HY, Song JH, Jung JK, Cha YD, et al. Comparison of the preventive effects of pretreatment of lidocaine with a tourniquet and a premixed injection of lidocaine on propofol-LCT/MCT injection pain. Korean J Anesthesiol. 2014;66(2):95.
Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:d1110.
Liljeroth E, Åkeson J. Less local pain on intravenous infusion of a new propofol emulsion. Acta Anaesthesiol Scandinavica. 2005;49(2):248-51.
Kim HS, Cho KR, Lee JH, Kim YH, Lim SH, Lee KM, et al. Prevention of pain during injection of microemulsion propofol: application of lidocaine mixture and the optimal dose of lidocaine. Korean J Anesthesiol. 2010;59(5):310.
So SY, Kim YH, Ko YK, Park SI, Pak HJ, Jung WS. Effect of lidocaine (40 mg) mixed to prevent injection pain of propofol on the intubating conditions and onset time of rocuronium. Korean J Anesthesiol. 2013;64(1):29.
Varghese E, Krishna HM, Nittala A. Does the newer preparation of propofol, an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine?. Paediatr Anaesth. 2010;20(4):338-42.
Lee BW, Kim SH, So KY. The effect of gender on EC50 of remifentanil to prevent pain during injection of microemulsion propofol. Korean J Anesthesiol. 2012;63(6):504.
Alipour M, Tabari M, Alipour M. Paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine and reduced propofol injection pain. Iran Red Cres Med J. 2014;16(3).
Lee M, Kwon T, Kim S, Kim S, Park K, Jeon Y. Comparative evaluation of the effect of remifentanil and 2 different doses of esmolol on pain during propofol injection: A double-blind, randomized clinical consort study. Med. 2017;96(10):e6288.
Salman EA, Titiz L, Akpek E, Arslan G. Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain. Agri. 2013;25(1):8-13.
Shivanna S, Priye S, Singh D, Jagannath S, Mudassar S, Reddy DP. Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised, double-blind, prospective study in adult cardiac surgical patients. Ind J Anaesth. 2016;60(11):848.
Mangar D, Holak EJ. Tourniquet at 50 mm Hg followed by intravenous lidocaine diminishes hand pain associated with propofol injection. Anesth Analg. 1992;74(2):250-2.
Singh A, Sharma G, Gupta R, Kumari A, Tikko D. Efficacy of tramadol and butorphanol pretreatment in reducing pain on propofol injection: A placebo-controlled randomized study. J Anaesthesiol, Clini Pharmacol. 2016;32(1):89.
Choi YJ, Park HS, Lee H, Yoon SZ. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol. 2012;63(5):413.
Sim JY, Lee SH, Park DY, Jung JA, Ki KH, Lee DH, et al. Pain on injection with microemulsion propofol. Brit J Clini Pharmacol. 2009;67(3):316-25.
Madan HK, Singh R, Sodhi GS. . Comparsion of Intravenous Lignocaine, Tramadol and Keterolac for Attenuation of Propofol Injection Pain. J Clin Diagn Res. 2016 Jul;10(7): UC05-8.
Le Guen M, Grassin-Delyle S, Cornet C, Genty A, Chazot T, Dardelle D, et al. Comparison of the Potency of Different Propofol FormulationsA Randomized, Double-blind Trial Using Closed-loop Administration. Anesthesiology: J Am Soc Anesthesiol. 2014;120(2):355-64.
Sarkar MS, Desai PM, Sageer H, Sarkar S. Propofol LCT vs propofol MCT-LCT: Randomized controlled trial. Ind J Clini Anaesth. 2016;3(2):214-8.
Ohmizo H, Obara S, Iwama H. Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol. Canadian J Anaesth. 2005;52(6):595.
Boku A, Inoue M, Hanamoto H, Oyamaguchi A, Kudo C, Sugimura M, et al. Effective dosage of midazolam to erase the memory of vascular pain during propofol administration. Anesthesia Progress. 2016 Sep;63(3):147-55.
Zahoor AB, Ahmed NA. The effects of duration of Propofol injection on hemodynamics. Middle East J Anesthesiol. 2010 Oct;20(6):845-50.
