JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS
AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
A&A International Anesthesia Research Society
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a colleague
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Aouad, M. T.
Right arrow Articles by Baraka, A. S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Aouad, M. T.
Right arrow Articles by Baraka, A. S.
Related Collections
Right arrow Pain Medicine
Right arrow Pain
Right arrow Pharmacology

Anesth Analg 2007;104:1540-1544
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000261520.34879.09

PAIN MEDICINE

Multimodal Analgesia to Prevent Propofol-Induced Pain: Pretreatment with Remifentanil and Lidocaine Versus Remifentanil or Lidocaine Alone

Marie T. Aouad, MD, Sahar M. Siddik-Sayyid, MD, FRCA, Achir A. Al-Alami, MD, and Anis S. Baraka, MD, FRCA

From the Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon.

Address correspondence to Marie T. Aouad, Associate Professor, Department of Anesthesiology, American University of Beirut Medical Center, P. O. Box 11 0236, Beirut, Lebanon. Address e-mail to mm01{at}aub.edu.lb.

BACKGROUND: Propofol is well-known for its pain on injection. Premixture with lidocaine or pretreatment with remifentanil reduces injection pain. A multimodal approach might offer additional mitigation of propofol injection pain.

METHODS: In a randomized, prospective, double-blind study of 156 patients, we compared the incidence and severity of propofol pain among three groups. Patients in the lidocaine group (n = 54) received 2% lidocaine premixed with propofol (40 mg lidocaine in 180 mg propofol). Patients in the remifentanil group (n = 50), received pretreatment with remifentanil 2 µg · kg–1 IV over 30 s. Patients in the combination group (n = 52) received both lidocaine and remifentanil.

RESULTS: A significant decrease in the overall incidence of propofol pain at induction was achieved in the combination group (9.6%) compared with that in the remifentanil group (36%) and the lidocaine group (35%) (P = 0.003). The incidence of severe and moderate pain was also significantly different in the combination group (0%), compared with that in the remifentanil (18%) and lidocaine groups (12.9%) (P < 0.02). Similar, statistically significant differences among the three groups were achieved concerning recalled pain in the postanesthesia care unit.

CONCLUSIONS: The combination of two different analgesic modalities, remifentanil and lidocaine completely abolishes moderate and severe pain associated with propofol injection, and significantly reduces the incidence of mild pain when compared with each drug used alone.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.