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PAIN MEDICINE

The Effect of Propofol on Thermal Pain Perception

From the Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama, the Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, University of Florida College of Dentistry, and Department of Clinical Health and Psychology, University of Florida College of Health Related Professions, Gainesville, Florida

Address correspondence and reprint requests to Michael A. Frölich, MD, MS, Department of Anesthesiology, 619 South 19th Street, Birmingham, AL 35249-6810. Address e-mail to froelich{at}uab.edu.

We studied the effect of propofol, a widely used sedative-hypnotic drug, on pain perception. Eighteen subjects received propofol in two sedative concentrations that were balanced and randomized in order. Painful (45°C, 47°C, and 49°C) stimulation temperatures were presented in random order, and nonpainful 31°C stimuli were presented on alternate trials. We used a target-controlled infusion and chose effect site concentrations of 0.5 µg/mL for mild sedation and 1.0 µg/mL for moderate sedation. Using a visual analog scale, subjects rated both pain intensity and unpleasantness higher when sedated with propofol. The average pain intensity was 28/100 for placebo, 35/100 for mild, and 40/100 for moderate sedation. Pain unpleasantness was 23/100 for placebo, 29/100 for mild, and 33/100 for moderate sedation. This effect was unexpected and may be explained by a difference of subjective pain experience by a patient and the perceived level of analgesia by a health care provider in sedated patients. This finding calls further attention to the need for adequate analgesia in patients sedated with propofol.

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