Paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine and reduced propofol injection pain

Mohammad Alipour, Masoomeh Tabari, Masoomeh Alipour, Mohammad Alipour, Masoomeh Tabari, Masoomeh Alipour

Abstract

Background: Propofol is a most widely used intravenous anesthetic drug. One of its most common complications is the pain upon injection; therefore, different methods, with various effects, have been proposed in order to alleviate the pain.

Objectives: This study investigates the effects of paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine drugs on reducing the pain of propofol injection during anesthetic induction. Also, the hemodynamic changes will be analyzed.

Patients and methods: This is an interventional study containing 336 patients underwent elective orthopedic surgeries in Educational Hospitals of Mashhad University, using systematic sampling, the patients were divided into six groups. A 20-gauge needle was inserted into a venous vessel in the back of the hand and 100 cc of Ringer serum was injected into the vein, which was applied proximal to the injection site. Afterwards, paracetamol 2 mg/kg (group p), magnesium sulfate 2 mmol (group M), ondansetron 4 mg (group O), granisetron 2 mg (group G), lidocaine 40 mg (group L) and 5 cc saline (group S) were injected into the vessel, after 60 seconds, the tourniquet was opened. One quarter of the total dose of propofol (2.5 mg/kg) was injected with a flow rate of 4 mg/sec and then the injection pain was measured. Finally, the fentanyl (2 µg/kg), atracurium 0.5 mg/kg, and the remaining dose of propofol were injected and the vital signs were recorded before the administration of propofol and 1, 3, 5 and 10 minutes after the propofol injection.

Results: The six groups did not significantly differ, regarding their gender, weight or age. Propofol injection pain was less in L and G groups, in comparison with the others (P ≤ 0.001). By analyzing the hemodynamic changes, it was observed that the least amount of change in mean arterial pressure was observed in the paracetamol group.

Conclusions: The reduction of propofol injection pain was observed by using medications (in comparison with normal saline), but it was more significant in groups G and L. Moreover, Hypotension was higher in groups S and G and it was lessened in group P.

Keywords: Acetaminophen; Granisetron; Lidocaine; Magnesium Sulfate; Ondansetron.

Figures

Figure 1.. Comparison of the Incidence of…
Figure 1.. Comparison of the Incidence of Pain in the Studied Groups

References

    1. Gupta S, Ravalia A, Jonnada HR. Pain on injection with propofol. Anaesthesia. 2001;56(10):1016.
    1. Wong WH, Cheong KF. Role of tramadol in reducing pain on propofol injection. Singapore Med J. 2001;42(5):193–5.
    1. Morton NS, Johnston G, White M, Marsh BJ. Propofol in paediatric anaesthesia. Pediatr Anesth. 1992;2(2):89–97. doi: 10.1111/j.1460-9592.1992.tb00182.x.
    1. Haugen RD, Vaghadia H, Waters T, Merrick PM. Thiopentone pretreatment for propofol injection pain in ambulatory patients. Can J Anaesth. 1995;42(12):1108–12. doi: 10.1007/BF03015097.
    1. El-Radaideh KM. [Effect of pretreatment with lidocaine, intravenous paracetamol and lidocaine-fentanyl on propofol injection pain. Comparative study. Rev Bras Anestesiol. 2007;57(1):32–8.
    1. Movafegh A. A Comparison Of Metoclopramide And Lidocaine For Preventing Pain On Injection Of Propofol. Tehran Univ Med J. 2003;61(4):274–80.
    1. Pang WW, Mok MS, Huang S, Hwang MH. The analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: a comparative study. Anesth Analg. 1998;86(2):382–6.
    1. Honarmand A, Safavi M. Magnesium sulphate pretreatment to alleviate pain on propofol injection: A comparison with ketamine or lidocaine. Acute Pain. 2008;10(1):23–9. doi: 10.1016/j.acpain.2008.01.001.
    1. Canbay O, Celebi N, Arun O, Karagoz AH, Saricaoglu F, Ozgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth. 2008;100(1):95–8. doi: 10.1093/bja/aem301.
    1. Iwama H, Nakane M, Ohmori S, Kaneko T, Kato M, Watanabe K, et al. Nafamostat mesilate, a kallikrein inhibitor, prevents pain on injection with propofol. Br J Anaesth. 1998;81(6):963–4.
    1. Zhao GY, Guo Y, Bao SM, Meng LX, Zhang LH. Prevention of propofol-induced pain in children: pretreatment with small doses of ketamine. J Clin Anesth. 2012;24(4):284–8. doi: 10.1016/j.jclinane.2011.08.013.
    1. Zahedi H, Maleki A, Rostami G. Ondansetron pretreatment reduces pain on injection of propofol. Acta Med Iran. 2012;50(4):239–43.
    1. Ahmed A, Sengupta S, Das T, Rudra A, Iqbal A. Pre-treatment with intravenous granisetron to alleviate pain on propofol injection: A double-blind, randomized, controlled trial. Indian J Anesth. 2012;56(2):135–8.
    1. Dubey PK, Prasad SS. Pain on injection of propofol: the effect of granisetron pretreatment. Clin J Pain. 2003;19(2):121–4.
    1. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90(4):963–9.
    1. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg. 2002;95(3):606–8.
    1. Shoaybi G, Soltanimohammadi S, Rajabi M. The effect of Magnesium sulfate on reducing Propofol injection pain in elective surgeries. Tehran Univ Med J. 2008;65(2):30–4.
    1. Agarwal A, Dhiraj S, Raza M, Pandey R, Pandey CK, Singh PK, et al. Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified. Can J Anaesth. 2004;51(2):130–3. doi: 10.1007/BF03018771.
    1. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. Eur J Anaesthesiol. 2010;27(3):253–7. doi: 10.1097/EJA.0b013e328330eca2.
    1. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:d1110. doi: 10.1136/bmj.d1110.

Source: PubMed

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