Efficacy of different fluids preload on propofol injection pain: A randomized, controlled, double-blinded study

Abstract

Injection pain of propofol remains a common clinical problem. Previous studies demonstrated that propofol injection pain was alleviated by applying nitroglycerin ointment to the skin of injection site, which inspires us to test whether venous vasodilation induced by fluid preload could alleviate the pain. Different types or volumes of fluid preload were compared. 200 ASA I–II adult patients were randomly assigned to five groups of 40 each. A 20 G cannula was established on the dorsum or wrist of the hand. When fluid preload given with Plasma-Lyte A 100 mL (P100 group), 250 mL (P250 group), 500 mL (P500 group), 0.9% saline 500 mL (N500 group) or Gelofusine 500 mL (G500 group) was completed within 30 min, respectively, Propofol (0.5 mg/kg, 1%) was injected at a rate of 0.5 mL/s. A blind investigator assessed the pain using a four-point scale. Incidence of pain in P100, P250, and P500 groups was 87.5%, 57.5% and 35%, respectively (P<0.05). The median pain intensity score was significantly lower in P500 group than that in P250 and P100 groups (P<0.05 and P<0.01, respectively). Comparison of the effect of different types of solution preload indicated that the highest incidence of pain was in N500 group (62.5%) (N500 vs. P500, P=0.014; N500 vs. G500, P=0.007). The median pain intensity score in N500 group was higher than that in P500 group (P<0.05) and G500 group (P<0.05). There was no significant difference between P500 and G500 groups. It is suggested that Plasma-Lyte A or Gelofusine preload with 500 mL before propofol injection is effective in alleviating propofol-induced pain.

Keywords

propofol / injection pain / Plasma-Lyte A / fluid preload / Gelofusine

References

[1] KooSW, ChoSJ, KimYK, et al.. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg, 2006, 103(6): 1444-1447

[2] ScottR, SaundersD, NormanJ. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia, 1988, 43(6): 492-494

[3] SolteszS, DiekmannM, Mitrenga-TheusingerA, et al.. Reduced pain on injection with a 0.5% propofol emulsion during induction of anesthesia. Eur J Anaesthesiol, 2012, 29(3): 162-163

[4] ReddyMS, ChenFG, NgHP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double-blind controlled comparison with lidocaine. Anaesthesia, 2001, 56(9): 902-905

[5] AgarwalA, DhirajS, RazaM, et al.. Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified. Can J Anaesth, 2004, 51(2): 130-133

[6] GhaiB, MakkarJK, BalaI, et al.. Effect of parecoxib pretreatment and venous occlusion on propofol injection pain: a prospective, randomized, double-blinded, placebo-controlled study. J Clin Anesth, 2010, 22(2): 88-92

[7] JeonY. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine. J Clin Anesth, 2012, 26(5): 728-731

[8] LeeJH, JungSY, KimMH, et al.. The effect of dexmedetomidine on propofol injection pain. Korean J Anesthesiol, 2014, 67: S30-31

[9] RizoliS. PlasmaLyte. J Trauma, 2011, 70: S17-S18

[10] McCrirrickA, HunterS. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia, 1990, 45(6): 443-444

[11] JohnsonRA, HarperNJ, ChadwickS, et al.. Pain on injection of propofol. Methods of alleviation. Anaesthesia, 1990, 45(6): 439-442

[12] JalotaL, KaliraV, GeorgeE, et al.. Perioperative Clinical Research C. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011, 342: d1110

[13] TanC, OnsiongM. Pain on injection of propofol. Anaesthesia, 1998, 53(5): 68-76

[14] TeohWHL, SiaATH. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg, 2009, 108(5): 1592-1598

[15] CanbayO, CelebiN, ArunO, et al.. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth, 2008, 100(1): 95-98

[16] NishimotoR, KashioM, TominagaM. Propofol-induced pain sensation involves multiple mechanisms in sensory neurons. Pflugers Arch, 2015, 467(9): 2011-2020

[17] Bundgaard-NielsenM, JorgensenCC, SecherNH, et al.. Functional intravascular volume deficit in patients before surgery. Acta Anaesthesiol Scand, 2010, 54(4): 464-469

[18] HolteK, KehletH. Compensatory fluid administration for preoperative dehydration—does it improve outcome. Acta Anaesthesiol Scand, 2002, 46(9): 1089-1093

[19] TuranA, KaramanliogluB, MemisD, et al.. Alternative application site of transdermal nitroglycerin and the reduction of pain on propofol injection. Eur J Anaesthesiol, 2003, 20(2): 170-172

[20] GalgonRE, StrubeP, HeierJ, et al.. Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial. J Anesth, 2015, 29(2): 206-211

[21] HonarmandA, SafaviM. Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine. Acute Pain, 2008, 10(1): 23-29

[22] MemisD, TuranA, KaramanlogluB, et al.. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg, 2002, 95(3): 606-608

[23] DedicA, AdamS, GommersD, et al.. Propofol injection pain: is it still an issue? The effect of premedication. Minerva Anestesiol, 2010, 76(9): 720-724