Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-19T11:33:51.301Z Has data issue: false hasContentIssue false
  • English
  • Français

A combination of lidocaine and nitrous oxide in oxygen is more effective in preventing pain on propofol injection than either treatment alone

Published online by Cambridge University Press:  29 April 2005

A. Niazi ,
E. Galvin ,
I. Elsaigh ,
Z. Wahid ,
D. Harmon  and
I. Leonard
A. Niazi
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland
E. Galvin
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland
I. Elsaigh
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland
Z. Wahid
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland
D. Harmon
Affiliation:
Cork University Hospital, Department of Anaesthesia and Intensive Care Medicine, Cork, Ireland
I. Leonard
Affiliation:
Beaumont Hospital, Department of Anaesthesia and Intensive Care Medicine, Dublin, Ireland
Get access

Abstract

Summary

Background and objective: Propofol is an intravenous (i.v.) anaesthetic agent that possesses many of the qualities of an ideal anaesthetic agent. The most significant side-effect associated with propofol is pain on injection. Despite optimal therapy, the incidence of pain on propofol injection remains a problem. This prospective, randomized, double blinded study evaluated the effect of three different treatment strategies in decreasing pain on propofol injection.

Methods: We studied 102 adult, ASA I–II patients, scheduled for elective surgical procedures. Combination of i.v. lidocaine and nitrous oxide (N2O) in oxygen (O2) inhalation pre-treatment was compared with either treatment alone in the prevention of pain on propofol injection. A standard propofol injection technique and scoring system, to measure the pain on injection was used.

Results: Demographic variables were similar between the groups. The incidence of no pain on propofol injection was similar in the lidocaine and N2O groups (63.6% vs. 57.5%) (95% confidence interval (CI): 0.17–0.29, P = 0.61). Combination therapy was associated with a greater incidence of no pain on injection (84% vs. 63.6%) (95% CI: 0.06–0.48, P = 0.04).

Conclusion: Combination of i.v. lidocaine and N2O in O2 inhalation pre-treatment is more effective than either treatment alone in decreasing pain on propofol injection.

Keywords

ANAESTHETICS, intravenous, propofol, lidocaineNITROUS OXIDECOMPLICATIONS, pain
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 4 , April 2005 , pp. 299 - 302
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Price ML, Walmsley A, Swaine C, Ponte J. Comparison of a total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery. Anaesthesia 1998; 43 (Suppl): 84–87.Google Scholar
McCollum JSC, Milligan KR, Dundee JW. The antiemetic action of propofol. Anaesthesia 1988; 43 (Suppl): 239–240.Google Scholar
Sear JW, Shaw I, Wolf A, Kay NH. Infusions of propofol to supplement nitrous oxide–oxygen for the maintenance of anaesthesia. A comparison with halothane. Anaesthesia 1988; 43 (Suppl): 18–22.Google Scholar
Stark RD, Binks SM, Dutka VN, et al. A review of the safety and tolerance of propofol (Diprivan). Postgrad Med J 1985; 61 (Suppl 3): 152–156.Google Scholar
Hynynen M, Korttila K, Tammisto T. Pain on i.v. injection of propofol (ICI 35 868) in emulsion formulation (Short communication). Acta Anaesthesiol Scand 1985; 29: 651–652.Google Scholar
Gehan G, Karoubi P, Quinet F, Leroy A, Rathat C, Pourriat JL. Optimal dose of lidocaine for preventing pain on injection of propofol. Br J Anaesth 1991; 66: 324–326.Google Scholar
McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia 1990; 45: 443–444.Google Scholar
Barker P, Langton JA, Murphy P, Rowbotham DJ. Effect of prior administration of cold saline on pain during propofol: a comparison with cold propofol and propofol with lignocaine. Anaesthesia 1991; 46: 1069–1070.Google Scholar
Stokes DN, Robson N, Hutton P. Effect of diluting propofol on the incidence of pain on injection and venous sequelae. Br J Anaesth 1989; 62: 202–203.Google Scholar
Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991; 67: 281–284.Google Scholar
Mackenzie JW. Attenuation of pain on injection of propofol – an unexpected benefit of co-induction with midazolam. Anaesthesia 1998; 53: 100.Google Scholar
Harmon D, Rozario C, Lowe D. Nitrous oxide/oxygen mixture and the prevention of pain during injection of propofol. Eur J Anaesthesiol 2003; 20: 158–161.Google Scholar
Picard P, Tramer MR. Prevention of pain on injection of propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–969.Google Scholar
Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998; 53 (5): 468–476.Google Scholar
Macario A, Weinger M, Troung P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999; 88: 1085–1091.Google Scholar
Scott RPF, Saunders DA, Norman J. Propofol: clinical strategies for preventing pain of injection. Anaesthesia 1988; 43: 492–494.Google Scholar
Briggs LP, Clarke RS, Dundee JW, Moore J, Bahar M, Wright PJ. Use of di-isopropyl phenol as main agent for short procedures. Br J Anaesth 1981; 53: 1197–1202.Google Scholar
Komatsu T, Shingu K, Tomemori N, et al. Nitrous oxide activates the supraspinal pain inhibition system. Acta Anaesthesiol Scand 1981; 25: 519–522.Google Scholar
Berkowitz BA, Finck AD, Ngai SH. Nitrous oxide analgesia: reversal by naloxone and development of tolerance. J Pharmacol Exp Ther 1977; 203: 539–547.Google Scholar
Beh T, Splinter W, Kim J. In children nitrous oxide decreases pain of injection of propofol mixed with lidocaine. Can J Anaesth 2002; 49: 1061–1063.Google Scholar
Mangar D, Holak EJ. Tourniquet at 50 mmHg followed by intravenous lidocaine diminishes hand pain associated with propofol injection. Anesth Analg 1992; 74: 250–252.Google Scholar
Gillman MA, Lichtigfeld FJ. Clinical role and mechanisms of action of analgesic nitrous oxide. Int J Neurosci 1988; 93: 55–62.Google Scholar
Haugen RD, Vaghadia H, Waters T, Merrick PM. Thiopentone pre-treatment for propofol injection pain in ambulatory patients. Can J Anaesth 1995; 42: 1108–1112.Google Scholar
Khoo ST, Woo M, Kumar A. Preoxygenation techniques: the value of nitrous oxide. Acta Anaesthesiol Scand 1993; 37: 23–25.Google Scholar