Alleviation of pain on intravenous injection of Propofol-Lipuro by dexamethasone and lignocaine pretreatment

Mohamed Essam Abdel-Meguid
Anesthesia Department, Ain Shams University, Cairo, Egypt

Correspondence Address:
Mohamed Essam Abdel-Meguid
MD, 10 Abdelazim Ashmawy St., Ard Elgolf, Thawra Road, Heliopolis, Cairo
Egypt

Source of Support: None, Conflict of Interest: None

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DOI: 10.7123/01.ASJA.0000423110.41947.fb

The use of lignocaine to prevent the pain of propofol injection is the most widely studied technique and is the most common method used in everyday practice. Many studies have shown the use of lignocaine to be effective. Two methods have been studied: pretreatment with lignocaine and mixing with propofol. Previous studies have found that lignocaine was associated with a lower incidence of injection pain, but the incidence was still high (31–40%). Our study aimed to investigate whether the incidence of injection pain could be further reduced by pretreatment with dexamethasone 8 mg/2 ml with 1-min venous occlusion.

In a randomized double-blind controlled trial, 120 patients were assigned to receive one of the following four options: group 1: pretreatment with 2 ml normal saline+18 ml Propofol-Lipuro premixed with 2 ml lignocaine 2%; group 2: pretreatment with 2 ml lignocaine 2%+Propofol-Lipuro premixed with 2 ml normal saline; group 3: pretreatment with dexamethasone 8 mg/2 ml+Propofol-Lipuro premixed with 2 ml normal saline; and group 4: pretreatment with 2 ml normal saline+18 ml Propofol-Lipuro premixed with 2 ml normal saline. Patients graded any associated pain or discomfort using a 4-point verbal rating scale.

Eight (26.6%) patients in groups 1 and 2, four (13.3%) patients in group 3, and 23 (76.6%) patients reported pain in group 4 (P<0.001). Five patients complained of moderate to severe pain in the lignocaine pretreatment or premixing groups (three moderate and two severe in group 1 and five moderate and zero severe in group 2). Compared with two patients who had moderate pain in the dexamethasone pretreatment group (group 3), 16 patients complained of moderate to severe pain in group 4 (six moderate and 10 severe).

Pretreatment with, or adding lignocaine, and pretreatment with dexamethasone reduced the incidence and severity of pain on an intravenous injection of Propofol-Lipuro.