Abstract
Purpose
t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not been examined. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared.
Methods
Two hundred adult patients randomly allocated to two groups were given 1.5 mg·kg-1 iv of either LCT propofol or LCT/MCT propofol at a rate of 200 mg·min-1 in a double-blind manner and were asked to grade pain scores. In another study, bradykinin and activated complement 3 (C3a) concentrations were measured using blood obtained from 13 healthy volunteers mixed with saline, LCT propofol or LCT/MCT propofol.
Results
There was a significant difference in pain scores between groups, showing a lower incidence of injection pain in the LCT/MCT propofol group. The bradykinin concentrations in blood mixed with LCT and LCT/MCT propofol were significantly higher than in blood mixed with saline. The C3a concentrations showed similar results.
Conclusions
LCT/MCT propofol causes less pain on injection compared with LCT propofol. Bradykinin generation and complement activation are similar with both LCT and LCT/MCT propofol. Thus, the reason for less pain on injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase.
Résumé
Objectif
On a pensé qu’une émulsion de propofol avec une chaîne mi-longue de triglycéride (CLT/CMT) cause moins de douleur à l’injection qu’une émulsion à chaîne longue (CLT) parce que la concentration de propofol diminue pendant la phase aqueuse. Aussi, le propofol avec CLT génère de la bradykinine, causant de la douleur à l’injection, et active le complément, mais ces effets n’ont pas été étudiés avec le propofol CLT/CMT. Pour définir le mécanisme qui réduit la douleur avec le propofol CLT/CMT, nous avons comparé la douleur à l’injection, la génération de bradykinine et l’activation du complément avec l’usage des deux produits de propofol.
Méthode
Deux cents patients adultes ont été répartis au hasard en deux groupes et ont reçu 1,5 mg·kg-1 iv de propofol CLT ou CLT/CMT à 200 mg·min-1 en double aveugle. On a demandé aux patients d’évaluer leur douleur. Dans une autre étude, les concentrations de bradykinine et de complément 3 activé (C3a) ont été mesurées dans des échantillons sanguins, obtenus de 13 volontaires sains, mêlés à une solution salée, à du propofol CLT ou CLT/CMT.
Résultats
On a noté une différence significative de scores de douleur, montrant une plus faible incidence avec le propofol CLT/CMT. Les concentrations de bradykinine dans le sang mêlé au propofol CLT et CLT/CMT ont été significativement plus élevées que dans le sang mêlé à la solution saline. Les concentrations de C3a ont montré des résultats similaires.
Conclusion
Le propofol CLT/CMT cause moins de douleur à l’injection que le propofol CLT. La génération de bradykinine et l’activation de complément sont similaires avec le propofol CLT et CLT/CMT. Par conséquent, la diminution de la douleur avec le propofol CLT/CMT peut être attribuée à la plus faible concentration de propofol pendant la phase aqueuse.
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Ohmizo, H., Obara, S. & Iwama, H. Mechanism of injection pain with long and longmedium chain triglyceride emulsive propofol. Can J Anesth 52, 595–599 (2005). https://doi.org/10.1007/BF03015768
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DOI: https://doi.org/10.1007/BF03015768