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LETTER TO THE EDITOR

Ketamine for Reducing Propofol-Induced Pain

Assistant Professor; Mount Sinai School of Medicine; New York, NY; david.wax{at}mssm.edu

To the Editor:

Given the high frequency of pain on injection of propofol, I read the report by Koo et al. (1) with hope of a better solution to the problem. They conclude that pretreatment with ketamine just before propofol injection is an effective method of reducing the incidence and intensity of such pain. Their data suggest that the reduction in pain may be superior to that achieved with lidocaine, the most common adjunct currently used for this purpose.

I question, however, the appropriateness of the comparison they utilized in their study protocol. Many investigations have shown that lidocaine is most effective when given IV during brief venous occlusion by tourniquet before propofol injection (2–4). Reportedly less effective (though faster and easier) is mixing lidocaine and propofol and injecting the mixture. The least effective method seems to be lidocaine pretreatment in the absence of a tourniquet. Unfortunately, it is this least effective method of using lidocaine that the authors chose for comparison with ketamine. Consequently, I am hesitant to accept ketamine as being superior to, or even equivalent to, best practices with lidocaine.

REFERENCES

1. Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg 2006;103:1444–7[Abstract/Free Full Text]
2. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90:963–9[Abstract/Free Full Text]
3. Lee P, Russell WJ. Preventing pain on injection of propofol: a comparison between lignocaine pre-treatment and lignocaine added to propofol. Anaesth Intensive Care 2004;32:482–4[Web of Science][Medline]
4. Massad IM, Abu-Ali HM, Abu-Halaweh SA, Badran IZ. Venous occlusion with lidocaine for preventing propofol induced pain. A prospective double-blind randomized study. Saudi Med J 2006; 27:997–1000[Web of Science][Medline]

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This Article 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 (1) Citing Articles via Google Scholar Google Scholar Articles by Wax, D. Search for Related Content PubMed PubMed Citation Articles by Wax, D.