Efficacy of different pharmacologic agents in reducing pain during propofol injection: a systematic review

ABSTRACT

Introduction: Propofol is a nonopioid intravenous anesthetic with a fast onset and short duration of action. It is commonly used as an induction agent, the sole agent in total intravenous anesthesia, or in short ambulatory procedures. One side effect of this drug is pain on injection. The pain on propofol injection can reach as much as 70%. Different pharmacologic interventions have been used to decrease propofol injection pain. The objective of this study is to determine the efficacy of different pharmacologic agents in reducing propofol injection pain. Materials and methods: A search for randomized controlled trials was done using electronic databases and manual searching. Letters were sent to anesthesiology departments nationwide for unpublished studies that may be included. Studies that met the inclusion criteria were appraised for methodological quality by two independent reviewers using the Physiotherapy Evidence database (PEDro) assessment tool. Meta-analysis was done using Review Manager (RevMan) Version 5.0 for Windows. Results: Sixteen studies were included in the review. Meta-analysis was done for lidocaine versus normal saline in decreasing propofol injection pain. Nineteen percent of patients complained of moderate pain and 7 percent complained of severe pain among those treated with lidocaine compared with 81% and 93%, respectively, among those given normal saline solution. the interventions not included in the meta-analysis were assessed based on the levels of evidence by Furlan. Conclusion: Lidocaine 40mg/IV given prior to propofol was efficacious in decreasing pain compared with normal saline solution. There is strong evidence for the use of remifentanil 0.01-0.02 mg or 2ug/kg as pretreatment in decreasing pain on propofol injection.