This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (119) Citing Articles via Google Scholar Google Scholar Articles by Picard, P. Articles by Tramèr, M. R. Search for Related Content PubMed PubMed Citation Articles by Picard, P. Articles by Tramèr, M. R.

---

GENERAL ARTICLES

Prevention of Pain on Injection with Propofol: A Quantitative Systematic Review

Pascale Picard, MD^*, and Martin R. Tramèr, MD, DPhil

*Consultation de la douleur, Service de pharmacologie clinique, CHU, Clermont-Ferrand Cedex, France; and Division d’Anesthésiologie, Département APSIC, Hôpitaux Universitaires de Genève, Genève, Switzerland

Address correspondence and reprint requests to Dr. M. R. Tramèr, Division of Anaesthesiology, Department APSIC, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland. Address e-mail to martin.tramer{at}hcuge.ch

The best intervention to prevent pain on injection with propofol is unknown. We conducted a systematic literature search (Medline, Embase, Cochrane Library, bibliographies, hand searching, any language, up to September 1999) for full reports of randomized comparisons of analgesic interventions with placebo to prevent that pain. We analyzed data from 6264 patients (mostly adults) of 56 reports. On average, 70% of the patients reported pain on injection. Fifteen drugs, 12 physical measurements, and combinations were tested. With IV lidocaine 40 mg, given with a tourniquet 30 to 120 s before the injection of propofol, the number of patients needed to be treated (NNT) to prevent pain in one who would have had pain had they received placebo was 1.6. The closest to this came meperidine 40 mg with tourniquet (NNT 1.9) and metoclopramide 10 mg with tourniquet (NNT 2.2). With lidocaine mixed with propofol, the best NNT was 2.4; with IV alfentanil or fentanyl, it was 3 to 4. IV lidocaine before the injection of propofol was less analgesic. Temperature had no significant effect. There was a lack of data for all other interventions to allow meaningful conclusions. The diameter of venous catheters and speed of injection had no impact on pain.

Implications: IV lidocaine (0.5 mg/kg) should be given with a rubber tourniquet on the forearm, 30 to 120 s before the injection of propofol; lidocaine will prevent pain in approximately 60% of the patients treated in this manner.

This article has been cited by other articles:

				H. J. Kwak, S. K. Min, J. S. Kim, and J. Y. Kim Prevention of propofol-induced pain in children: combination of alfentanil and lidocaine vs alfentanil or lidocaine alone Br. J. Anaesth., September 1, 2009; 103(3): 410 - 412. [Abstract] [Full Text] [PDF]

				P. M. Cornett, J. A. Matta, and G. P. Ahern General Anesthetics Sensitize the Capsaicin Receptor Transient Receptor Potential V1 Mol. Pharmacol., November 1, 2008; 74(5): 1261 - 1268. [Abstract] [Full Text] [PDF]

				A. Rochette, A. F. Hocquet, C. Dadure, D. Boufroukh, O. Raux, J. F. Lubrano, S. Bringuier, and X. Capdevila Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study Br. J. Anaesth., September 1, 2008; 101(3): 390 - 394. [Abstract] [Full Text] [PDF]

				J. A. Matta, P. M. Cornett, R. L. Miyares, K. Abe, N. Sahibzada, and G. P. Ahern From the Cover: General anesthetics activate a nociceptive ion channel to enhance pain and inflammation PNAS, June 24, 2008; 105(25): 8784 - 8789. [Abstract] [Full Text] [PDF]

				S. Yavas, D. Lizdas, N. Gravenstein, and S. Lampotang Interactive Web Simulation for Propofol and Fospropofol, a New Propofol Prodrug Anesth. Analg., March 1, 2008; 106(3): 880 - 883. [Abstract] [Full Text] [PDF]

				O. Canbay, N. Celebi, O. Arun, A. H. Karagoz, F. Saricaoglu, and S. Ozgen Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain Br. J. Anaesth., January 1, 2008; 100(1): 95 - 98. [Abstract] [Full Text] [PDF]

				J.-R. Lee, C.-W. Jung, and Y.-H. Lee Reduction of pain during induction with target-controlled propofol and remifentanil Br. J. Anaesth., December 1, 2007; 99(6): 876 - 880. [Abstract] [Full Text] [PDF]

				Z. Tabboush Ketamine Versus Lidocaine for the Pain of Propofol Injection Anesth. Analg., August 1, 2007; 105(2): 539 - 540. [Full Text] [PDF]

				D. Wax Ketamine for Reducing Propofol-Induced Pain Anesth. Analg., August 1, 2007; 105(2): 540 - 540. [Full Text] [PDF]

				M. T. Aouad, S. M. Siddik-Sayyid, A. A. Al-Alami, and A. S. Baraka Multimodal Analgesia to Prevent Propofol-Induced Pain: Pretreatment with Remifentanil and Lidocaine Versus Remifentanil or Lidocaine Alone Anesth. Analg., June 1, 2007; 104(6): 1540 - 1544. [Abstract] [Full Text] [PDF]

				S.-W. Koo, S.-J. Cho, Y.-K. Kim, K.-D. Ham, and J.-H. Hwang Small-Dose Ketamine Reduces the Pain of Propofol Injection Anesth. Analg., December 1, 2006; 103(6): 1444 - 1447. [Abstract] [Full Text] [PDF]

				Y. Nyman, K. Von Hofsten, C. Palm, S. Eksborg, and P. A. Lonnqvist Etomidate-(R)Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine Br. J. Anaesth., October 1, 2006; 97(4): 536 - 539. [Abstract] [Full Text] [PDF]

				P. K. Dubey and A. Kumar Pain on Injection of Lipid-Free Propofol and Propofol Emulsion Containing Medium-Chain Triglyceride: A Comparative Study Anesth. Analg., October 1, 2005; 101(4): 1060 - 1062. [Abstract] [Full Text] [PDF]

				N. C. H. Sun, A. Y. C. Wong, and M. G. Irwin A Comparison of Pain on Intravenous Injection Between Two Preparations of Propofol Anesth. Analg., September 1, 2005; 101(3): 675 - 678. [Abstract] [Full Text] [PDF]

				Y. Nyman, K. von Hofsten, A. Georgiadi, S. Eksborg, and P. A. Lonnqvist Propofol injection pain in children: a prospective randomized double-blind trial of a new propofol formulation versus propofol with added lidocaine Br. J. Anaesth., August 1, 2005; 95(2): 222 - 225. [Abstract] [Full Text] [PDF]

				M. Yamakage, S. Iwasaki, J.-I. Satoh, and A. Namiki Changes in Concentrations of Free Propofol by Modification of the Solution Anesth. Analg., August 1, 2005; 101(2): 385 - 388. [Abstract] [Full Text] [PDF]

				E. Schaub, C. Kern, and R. Landau Comparison of Propofol with Lidocaine Pretreatment Versus Propofol Formulated with Long- and Medium-Chain Triglycerides or Confounding Effect of Tourniquet Anesth. Analg., July 1, 2005; 101(1): 301 - 302. [Full Text] [PDF]

				W. S. Yew, S. Y. Chong, K. H. Tan, and M. H. Goh The Effects of Intravenous Lidocaine on Pain During Injection of Medium- and Long-Chain Triglyceride Propofol Emulsions Anesth. Analg., June 1, 2005; 100(6): 1693 - 1695. [Abstract] [Full Text] [PDF]

				N. Ahmad, C. Y. Choy, E. A. Aris, and S. Balan Preventing the Withdrawal Response Associated with Rocuronium Injection: A Comparison of Fentanyl with Lidocaine Anesth. Analg., April 1, 2005; 100(4): 987 - 990. [Abstract] [Full Text] [PDF]

				S. C. Minogue and D. A. Sun Bacteriostatic Saline Containing Benzyl Alcohol Decreases the Pain Associated with the Injection of Propofol Anesth. Analg., March 1, 2005; 100(3): 683 - 686. [Abstract] [Full Text] [PDF]

				E. Schaub, C. Kern, and R. Landau Pain on Injection: A Double-Blind Comparison of Propofol with Lidocaine Pretreatment Versus Propofol Formulated with Long- and Medium-Chain Triglycerides Anesth. Analg., December 1, 2004; 99(6): 1699 - 1702. [Abstract] [Full Text] [PDF]

				S. Adam, J. van Bommel, M. Pelka, M. Dirckx, D. Jonsson, and J. Klein Propofol-Induced Injection Pain: Comparison of a Modified Propofol Emulsion to Standard Propofol with Premixed Lidocaine Anesth. Analg., October 1, 2004; 99(4): 1076 - 1079. [Abstract] [Full Text] [PDF]

				A. Agarwal, M. Raza, S. Dhiraaj, R. Pandey, D. Gupta, C. K. Pandey, P. K Singh, and U. Singh Pain During Injection of Propofol: The Effect of Prior Administration of Butorphanol Anesth. Analg., July 1, 2004; 99(1): 117 - 119. [Abstract] [Full Text] [PDF]

				A. Agarwal, M. F. Ansari, D. Gupta, R. Pandey, M. Raza, P. K. Singh, Shiopriye, S. Dhiraj, and U. Singh Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection Anesth. Analg., March 1, 2004; 98(3): 683 - 686. [Abstract] [Full Text] [PDF]

				E. von Elm, G. Poglia, B. Walder, and M. R. Tramer Different Patterns of Duplicate Publication: An Analysis of Articles Used in Systematic Reviews JAMA, February 25, 2004; 291(8): 974 - 980. [Abstract] [Full Text] [PDF]

				A. McCluskey, B. A. Currer, and I. Sayeed The Efficacy of 5% Lidocaine-Prilocaine (EMLA) Cream on Pain During Intravenous Injection of Propofol Anesth. Analg., September 1, 2003; 97(3): 713 - 714. [Abstract] [Full Text] [PDF]

				J. W. Park, E.-S. Park, S.-C. Chi, H. Y. Kil, and K.-H. Lee The Effect of Lidocaine on the Globule Size Distribution of Propofol Emulsions Anesth. Analg., September 1, 2003; 97(3): 769 - 771. [Abstract] [Full Text] [PDF]

				L.-H. Tan and N.-C. Hwang The Effect of Mixing Lidocaine with Propofol on the Dose of Propofol Required for Induction of Anesthesia Anesth. Analg., August 1, 2003; 97(2): 461 - 464. [Abstract] [Full Text] [PDF]

				M. Pellegrini, C. Lysakowski, L. Dumont, A. Borgeat, and E. Tassonyi Propofol 1% versus propofol 2% in children undergoing minor ENT surgery Br. J. Anaesth., March 1, 2003; 90(3): 375 - 377. [Abstract] [Full Text] [PDF]

				M. A. Cheong, K. S. Kim, and W. J. Choi Ephedrine Reduces the Pain from Propofol Injection Anesth. Analg., November 1, 2002; 95(5): 1293 - 1296. [Abstract] [Full Text] [PDF]

				H. Majedi, M. Rabiee, Z. Hussain Khan, and B. Hassannasab A Comparison of Metoclopramide and Lidocaine for Preventing Pain on Injection of Diazepam Anesth. Analg., November 1, 2002; 95(5): 1297 - 1299. [Abstract] [Full Text] [PDF]

				B. Walder, M. R. Tramer, and M. Seeck Seizure-like phenomena and propofol: A systematic review Neurology, May 14, 2002; 58(9): 1327 - 1332. [Abstract] [Full Text] [PDF]

				G. Basaranoglu, V. Erden, and H. Delatioglu Reduction of Pain on Injection of Propofol: A Comparison of Fentanyl with Remifentanil Anesth. Analg., April 1, 2002; 94(4): 1040 - 1041. [Full Text] [PDF]

				P. Kranke, L. H. Eberhart, N. Roewer, and M. R. Tramer Pharmacological Treatment of Postoperative Shivering: A Quantitative Systematic Review of Randomized Controlled Trials Anesth. Analg., February 1, 2002; 94(2): 453 - 460. [Abstract] [Full Text] [PDF]