Abstract
Purpose
Regardless of the positive attributes of propofol, it is frequently associated with pain on injection. We compared the efficacy of topical cold thermotherapy using an ice gel pack with intravenous lignocaine pre-treatment for reducing pain on propofol injection.
Methods
This single-blinded randomized controlled trial was conducted in 200 American Society of Anesthesiologists physical status I, II, and III patients scheduled for elective/emergency surgery under general anesthesia. The patients were randomized into two groups: the Thermotherapy group- receiving an ice gel pack proximal to the intravenous cannula for 1 min, or the Lignocaine group-receiving 0.5 mg/kg of lignocaine administered intravenously, with occlusion proximal to the site of the intravenous cannula for 30 s. The primary objective was to compare the overall incidence of pain after propofol injection. The secondary objectives included the incidence of discomfort on the application of an ice gel pack, comparison of dose of propofol needed for induction, and hemodynamic changes at induction, between the two groups.
Results
Fourteen patients in the lignocaine group and 15 patients in the thermotherapy group reported pain. The incidence of pain and the distribution of pain scores were comparable among groups (p = 1.00). Patients of the lignocaine group required significantly less amount of propofol for induction as compared to the thermotherapy group (p = 0.001).
Conclusion
Topical thermotherapy using an ice gel pack was not found superior to lignocaine pre-treatment in alleviating pain on injection of propofol injection. However, topical cold therapy using an ice pack remains a non-pharmacological technique that is easily available, reproducible, and cost-effective. Further studies are required to prove its equivalence to lignocaine pre-treatment.
Trial registration
CTRI (CTRI/2021/04/032950).
Similar content being viewed by others
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
References
Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90(4):963–9. https://doi.org/10.1097/00000539-200004000-00035.
Lu Y, Gu Y, Liu L, Tang X, Xia Q, Xu Z. Intravenous dexmedetomidine administration prior anesthesia induction with propofol at 4°C attenuates propofol injection pain: a double-blind, randomized, placebo-controlled trial. Front Med (Lausanne). 2021;8:590465. https://doi.org/10.3389/fmed.2021.590465.
Desousa KA. Pain on propofol injection: causes and remedies. Indian J Pharmacol. 2016;48(6):617–23. https://doi.org/10.4103/0253-7613.194845.
Iwata M, Inoue S, Kawaguchi M, Kimura T, Tojo T, Taniguchi S, Furuya H. Ketamine eliminates propofol pain but does not affect hemodynamics during induction with double-lumen tubes. J Anesth. 2010;24(1):31–7. https://doi.org/10.1007/s00540-009-0833-5.
Singla B, Malde AD. A prospective observational study of injection pain in children with medium plus long chain triglyceride and long chain triglyceride propofol premixed with lignocaine. Indian J Anaesth. 2018;62(3):214–8. https://doi.org/10.4103/ija.IJA_506_17.
Turan A, Karamanlioğlu B, Memiş D, Pamukçu Z. Alternative application site of transdermal nitroglycerin and the reduction of pain on propofol injection. Eur J Anaesthesiol. 2003;20(2):170–2. https://doi.org/10.1017/s0265021503260300.
Memiş D, Turan A, Karamanlioglu B, Kaya G, Pamukçu Z. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesthesiol. 2002;19(1):47–51. https://doi.org/10.1017/s0265021502000078.
Kim DH, Chae YJ, Chang HS, Kim JA, Joe HB. Intravenous lidocaine pretreatment with venous occlusion for reducing microemulsion propofol induced pain: comparison of three doses of lidocaine. J Int Med Res. 2014;42(2):368–75. https://doi.org/10.1177/0300060513507391.
Xing J, Liang L, Zhou S, Luo C, Cai J, Hei Z. Intravenous lidocaine alleviates the pain of propofol injection by local anesthetic and central analgesic effects. Pain Med. 2018;19(3):598–607. https://doi.org/10.1093/pm/pnx070.
Cho SY, Jeong CW, Jeong CY, Lee HG. Efficacy of the combination of cold propofol and pretreatment with remifentail on propofol injection pain. Korean J Anesthesiol. 2010;59(5):305–9. https://doi.org/10.4097/kjae.2010.59.5.305.
Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01-4. https://doi.org/10.7860/JCDR/2014/7404.4818.
McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia. 1990;45(6):443–4. https://doi.org/10.1111/j.1365-2044.1990.tb14329.x.
Terada N, Takubo I, Fujinaka W, Takatori M. Effectiveness of local cooling and lidocaine administration for prevention of pain upon injection of propofol. Masui. 2014;63(8):836–40.
Euasobhon P, Dej-Arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, Lumbiganon P. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016;2(2):CD007874. https://doi.org/10.1002/14651858.CD007874.pub2.
Agarwal A, Dhiraaj S, Raza M, Singhal V, Gupta D, Ranjan R, Singh PK, Singh U. Pain during injection of propofol: the effect of prior administration of ephedrine. AnaesthIntensive Care. 2004;32(5):657–60. https://doi.org/10.1177/0310057X0403200508.
Masaki Y, Tanaka M, Nishikawa T. Physicochemical compatibility of propofol-lidocaine mixture. Anesth Analg. 2003;97(6):1646–51. https://doi.org/10.1213/01.ANE.0000087802.50796.FB.
Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel CC, Perioperative Clinical Research Core. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:d1110. https://doi.org/10.1136/bmj.d1110.
Ahmad S, De Oliveira GS Jr., Fitzgerald PC, McCarthy RJ. The effect of intravenous dexamethasone and lidocaine on propofol-induced vascular pain: a randomized double-blinded placebo-controlled trial. Pain Res Treat. 2013;2013:734531. https://doi.org/10.1155/2013/734531.
Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manag. 1994;9(1):56–9. https://doi.org/10.1016/0885-3924(94)90150-3.
Hans GA, Lauwick SM, Kaba A, Bonhomme V, Struys MM, Hans PC, Lamy ML, Joris JL. Intravenous lidocaine infusion reduces bispectral index-guided requirements of propofol only during surgical stimulation. Br J Anaesth. 2010;105(4):471–9. https://doi.org/10.1093/bja/aeq189.
Forster C, Vanhaudenhuyse A, Gast P, Louis E, Hick G, Brichant JF, Joris J. Intravenous infusion of lidocaine significantly reduces propofol dose for colonoscopy: a randomised placebo-controlled study. Br J Anaesth. 2018;121(5):1059–64. https://doi.org/10.1016/j.bja.2018.06.019.
Burman S, Sehgal R, Gupta S, Gupta N, Sood J. Evaluation of analgesic and hemodynamic efficacy of ephedrine versus lignocaine during propofol injection. Curr Med Res Pract. 2019;9(4):145–9.
Kinthala S, Durga P, Tirumala S, Ramachandran G, Kurnutala LN. Efficacy of ephedrine versus lignocaine pretreatment in preventing pain following propofol injection: a prospective, randomized, double-blind, placebo-controlled study. Internet J Anesthesiol. 2013. https://doi.org/10.5580/2cec.
Funding
None.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Karki, Y., Sarna, R., Singh, N. et al. Prevention of pain on injection of propofol using ice gel pack versus pre-treatment with lignocaine: a randomized controlled trial. J Anesth 37, 616–623 (2023). https://doi.org/10.1007/s00540-023-03216-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-023-03216-1