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Service d’Anesthésiologie, Département d’Anesthésiologie, Pharmacologie et Soins Intensifs de Chirurgie (APSIC), Hôpitaux Universitaires de Genève, Switzerland
Address correspondence and reprint requests to Dr. Ruth Landau, Service d’Anesthésiologie, Hôpitaux Universitaires de Genève, Rue Micheli du Crest 24, 1211 Genève 14, Switzerland. Address e-mail to ruth.landau{at}hcuge.ch
The incidence of pain on injection of propofol has been reported to be 70%. A new propofol formulation with a 10% emulsion of long- and medium-chain triglycerides (LCT/MCT) is associated with less pain on injection. Our goal was to compare the effect of propofol-LCT/MCT on the incidence of pain versus propofol with lidocaine 40 mg IV pretreatment injected as a Bier’s block. Two hundred healthy women scheduled for ambulatory gynecological procedures were allocated to 1 of 2 groups in a randomized double-blind fashion. Group LIDO received lidocaine 2% 2 mL injected with a tourniquet 1 min before propofol 1% 2 mg/kg IV; group LCT/MCT received NaCl 0.9% 2 mL with tourniquet 1 min before propofol-LCT/MCT 1% 2 mg/kg IV. Spontaneous verbal expressions of pain, movement of hand, frowning, and moaning during the injection were recorded. The incidence and severity of pain were assessed 30 min and 6 h after surgery. Recall of pain was considered with a visual analog scale (VAS) score >1, and pain was graded as VAS 0–10. More women reported spontaneous verbal expression of pain with propofol-LCT/MCT (47% versus 24%; P = 0.0014; relative risk 1.61 [95% confidence interval, 1.22–2.13]). Among women with a painful injection, there was no difference after surgery regarding the intensity of pain or recall of pain. In contrast to previous reports, we found that propofol-LCT/MCT resulted in a more frequent incidence of pain than propofol 1% with IV lidocaine pretreatment. This may be due to the diversity of pain definitions used in studies or to the lack of premedication in our study.
IMPLICATIONS: Propofol–long- and medium-chain triglycerides resulted in a more frequent incidence of pain upon injection than propofol with 40 mg IV of lidocaine pretreatment as a Bier’s block (47% versus 24%, respectively).
This article has been cited by other articles:
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  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]
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 P. Eghtesadi-Araghi and S. M. Marashi 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 - 301. [Full Text] [PDF]
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S. Adam, J. van Bommel, M. Pelka, M. Dirckx, D. Jonsson, and J. Klein Propofol-Induced Injection Pain: Comparison of a Modified Propofol Emulsion and Standard Propofol with Premixed Lidocaine Anesth. Analg., June 1, 2005; 100(6): 1858 - 1859. [Full Text] [PDF]
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