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

  • Shi-ying Yuan (袁世荧)
  • Tian-yuan Luo (罗天元)
  • Zhen Liu (刘 真)
  • Yun Lin (林 云)Email author


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.

Key words

propofol injection pain Plasma-Lyte A fluid preload Gelofusine 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Koo SW, Cho SJ, Kim YK, et al. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg, 2006,103(6):1444–1447CrossRefPubMedGoogle Scholar
  2. 2.
    Scott R, Saunders D, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia, 1988,43(6):492–494CrossRefPubMedGoogle Scholar
  3. 3.
    Soltesz S, Diekmann M, Mitrenga-Theusinger A, et al. Reduced pain on injection with a 0.5% propofol emulsion during induction of anesthesia. Eur J Anaesthesiol, 2012,29(3):162–163CrossRefPubMedGoogle Scholar
  4. 4.
    Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double-blind controlled comparison with lidocaine. Anaesthesia, 2001,56(9):902–905CrossRefPubMedGoogle Scholar
  5. 5.
    Agarwal A, Dhiraj S, Raza M, et al. Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified. Can J Anaesth, 2004,51(2): 130–133CrossRefPubMedGoogle Scholar
  6. 6.
    Ghai B, Makkar JK, Bala I, 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):88–92CrossRefPubMedGoogle Scholar
  7. 7.
    Jeon Y. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine. J Clin Anesth, 2012,26(5):728–731Google Scholar
  8. 8.
    Lee JH, Jung SY, Kim MH, et al. The effect of dexmedetomidine on propofol injection pain. Korean J Anesthesiol, 2014,67(Suppl):S30–31CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Rizoli S. PlasmaLyte. J Trauma, 2011,70(5 Suppl):S17–S18CrossRefPubMedGoogle Scholar
  10. 10.
    McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia, 1990,45(6):443–444CrossRefPubMedGoogle Scholar
  11. 11.
    Johnson RA, Harper NJ, Chadwick S, et al. Pain on injection of propofol. Methods of alleviation. Anaesthesia, 1990,45(6):439–442CrossRefPubMedGoogle Scholar
  12. 12.
    Jalota L, Kalira V, George E, et al. Perioperative Clinical Research C. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ, 2011,342: d1110CrossRefPubMedGoogle Scholar
  13. 13.
    Tan C, Onsiong M. Pain on injection of propofol. Anaesthesia, 1998,53(5):68–76CrossRefGoogle Scholar
  14. 14.
    Teoh WHL, Sia ATH. Colloid preload versus coload for spinal anesthesia for cesarean delivery: the effects on maternal cardiac output. Anesth Analg, 2009,108(5): 1592–1598CrossRefPubMedGoogle Scholar
  15. 15.
    Canbay O, Celebi N, Arun O, et al. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth, 2008,100(1):95–98CrossRefPubMedGoogle Scholar
  16. 16.
    Nishimoto R, Kashio M, Tominaga M. Propofol-induced pain sensation involves multiple mechanisms in sensory neurons. Pflugers Arch, 2015,467(9):2011–2020CrossRefPubMedGoogle Scholar
  17. 17.
    Bundgaard-Nielsen M, Jorgensen CC, Secher NH, et al. Functional intravascular volume deficit in patients before surgery. Acta Anaesthesiol Scand, 2010,54(4):464–469CrossRefPubMedGoogle Scholar
  18. 18.
    Holte K, Kehlet H. Compensatory fluid administration for preoperative dehydration—does it improve outcome? Acta Anaesthesiol Scand, 2002,46(9):1089–1093CrossRefPubMedGoogle Scholar
  19. 19.
    Turan A, Karamanlioglu B, Memis D, et al. Alternative application site of transdermal nitroglycerin and the reduction of pain on propofol injection. Eur J Anaesthesiol, 2003,20(2):170–172CrossRefPubMedGoogle Scholar
  20. 20.
    Galgon RE, Strube P, Heier J, et al. Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial. J Anesth, 2015,29(2):206–211CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Honarmand A, Safavi M. Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine. Acute Pain, 2008,10(1):23–29CrossRefGoogle Scholar
  22. 22.
    Memis D, Turan A, Karamanloglu B, et al. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg, 2002,95(3):606–608CrossRefPubMedGoogle Scholar
  23. 23.
    Dedic A, Adam S, Gommers D, et al. Propofol injection pain: is it still an issue? The effect of premedication. Minerva Anestesiol, 2010,76(9):720–724PubMedGoogle Scholar

Copyright information

© Huazhong University of Science and Technology and Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Shi-ying Yuan (袁世荧)
    • 1
  • Tian-yuan Luo (罗天元)
    • 2
  • Zhen Liu (刘 真)
    • 3
  • Yun Lin (林 云)
    • 1
    Email author
  1. 1.Department of Anesthesiology and Intensive Care Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Department of AnesthesiologyAffiliated Hospital of Zunyi Medical CollegeZunyiChina
  3. 3.Department of AnesthesiologyPeking Union Medical College HospitalBeijingChina

Personalised recommendations