Prevention of propofol injection induced pain: A comparison of acetaminophen with lidocaine

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Prevention of propofol injection induced pain: A comparison of acetaminophen with lidocaine

Journal Title: Scholars Journal of Applied Medical Sciences - Year 2016, Vol 4, Issue 5

Abstract

Propofol is a commonly used intravenous anaesthetic and is often the induction agent of choice. However pain on injection is a major drawback. Interventions to mitigate the pain have included selecting larger hand veins for injection, cooling or warming the drug pre-treatment with drugs like lidocaine, ephedrine, ondansetron, metoclopramide, opioids, thiopental, ketorolac, nafamostat, nonsteroidal anti-inflammatory drugs etc. As an alternative to these, acetaminophen is being used to decrease propofol –injection pain. The Aim was to study the efficacy of acetaminophen in decreasing the pain on injection of propofol and compare it with lidocaine. A randomised, double blind controlled study 150 patients aged 18-60 years classified as ASA physical status I or II scheduled for elective surgery, were assigned to one of the three groups. After securing a 20G I.V cannula in largest superficial vein on the dorsum of the hand, Lacted Ringer solution was started at the rate of 100ml /hr. After 5 minutes the infusion was stopped. A Pneumatic tourniquet was applied to the upper arm and the limb elevated for 15 seconds for drainage of venous blood. Tourniquet pressure was raised to 70 mm Hg. Patients were pretreated over 5 seconds with one of the study drugs i.e. 50mg (5ml) of acetaminophen (group A) or 50mg (5ml) lidocaine (group L) or (5ml) normal saline (groups).After 2 minutes, occlusion was released and one fourth of the total calculated dose(2mg/kg) of propofol was injected over 5 seconds. The pain that occurred during propofol injection was assessed on a four point verbal rating scale (none=0 mild=1 moderate=2 severe=3). In Results Group A (acetaminophen) - 30% had mild, 16% moderate and 4% severe pain after injection of propofol. 50% had no pain at all. Group L (Lidocaine) - 12% had mild, 2% moderate, none experienced severe pain. 86% were pain free. Group S (normal saline) - 54% had mild, 14% moderate and 4% severe pain. 28% were pain free. In Conclusion we concluded that lidocaine is superior to acetaminophen in reducing the pain on injection of propofol. Keywords: Propofol, Pain on injection, Acetaminophen, Lidocaine

Authors and Affiliations

Dr. Sarita Fernandes, Dr Charusheela Thombre

Keywords

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EP ID EP370969
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