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Anesth Analg 2004;99:1076-1079
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000130344.17898.CD

AMBULATORY ANESTHESIA

Propofol-Induced Injection Pain: Comparison of a Modified Propofol Emulsion to Standard Propofol with Premixed Lidocaine

Sigrid Adam, MD, Jasper van Bommel, MD PhD, Michal Pelka, Maaike Dirckx, MD, David Jonsson, MD, and Jan Klein, MD PhD

Department of Anesthesiology, Erasmus Medical Center Rotterdam, The Netherlands

Address correspondence and reprint requests to Sigrid Adam, MD, Department of Anesthesiology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Address e-mail to s.adam{at}erasmusmc.nl

Propofol is well known for its association with pain on injection. The most frequently used method to reduce this pain is premixture with lidocaine. Recently, a modified lipid emulsion of propofol containing medium-chain triglycerides (MCT) with long-chain triglycerides (LCT), in contrast to the usual LCT formulation, has been advocated to alleviate pain. In a randomized, prospective, controlled, double-blind study on 222 surgical patients, we compared the effect of the two solutions on the incidence and intensity of injection pain. Patients were randomly allocated to receive either propofol MCT/LCT (group M; n = 109) or standard propofol LCT with the addition of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of propofol (group L; n = 113). Pain scores were assessed using a verbal analog scale (VAS) ranging from 0–10. Group L was found to have significantly less pain on the injection of propofol (mean VAS, 2.5 ± 2.9) (mean ± SD) than group M (mean VAS, 3.8 ± 3.2; P = 0.002). Regarding postoperative recall of pain on injection, patients in group L indicated significantly less pain (mean VAS, 2.2 ± 2.4) than patients in group M (mean VAS, 3.0 ± 2.7; P = 0.02). Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol LCT causes less pain on injection than propofol MCT/LCT and thus increases patient comfort.

IMPLICATIONS: Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol containing long-chain triglycerides (LCT) causes less pain on injection than propofol containing both medium-chain triglycerides (MCT) and LCT and thus increases patient comfort.




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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 © 2004 by the International Anesthesia Research Society.