Reduction of propofol infusion pain using target controlled infusion of remifentanil

ABSTRACT

BACKGROUND: Propofol has a high incidence of infusion pain. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target controlled infusions (TCI) of both drugs were used. We compared the efficacy of remifentanil TCI administered 90 seconds before propofol TCI with remifentanil TCI and propofol TCI given immediately after a 40 mg lidocaine bolus in prevention of propofol infusion pain. METHODS: One hundred sixty five ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups. Group C: propofol TCI and remifentanil TCI was started at the same time (n = 55), group L: lidocaine 40 mg injection immediately prior to propofol TCI and remifentanil TCI (n = 55), group R: remifentanil TCI was started 90 seconds before propofol TCI (n = 55). Pain severity of propofol infusion was evaluated using a four-point scale (none, mild, moderate, severe). RESULTS: The incidence of pain in group R and group L was significantly lower than in group C. There was no significant difference between group R and group L. But the incidence of moderate and severe pain in group R was significantly lower than in group L (P < 0.05). CONCLUSIONS: Remifentanil TCI 90 seconds before propofol TCI reduces propofol infusion pain than propofol TCI and remifentanil TCI started at the same time. This protocol is considered to be more effective in alleviating moderate and severe pain than lidocaine.