Article

Role of tramadol in reducing pain on propofol injection

Department of Anaesthesia, National University Hospital, Singapore.
Singapore medical journal (Impact Factor: 0.6). 05/2001; 42(5):193-5.
Source: PubMed

ABSTRACT

Propofol is frequently associated with pain on injection. We evaluated the effect of tramadol in a randomised, double-blind study using a tourniquet venous retention technique. Normal saline placebo was given intravenously to patients in Group 1 (n = 30),tramadol 50 mg to Group 2 (n = 30), and lignocaine 50 mg to Group 3 (n = 30). The venous retention of drugs was maintained for 1 minute, followed by tourniquet release and intravenous administration of propofol. Pain assessment was made immediately after propofol injection. There was a significant reduction in the incidence of pain associated with propofol administration in patients pretreated with lignocaine and tramadol (P < 0.05). In addition, pretreatment with tramadol was as effective as lignocaine in reducing pain on propofol injection.

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    • "Various techniques have been used in different studies in order to decrease the pain of propofol injection, including diluting propofol, cooling or heating, using larger vessels for injection or adding lidocaine. Also, The drugs which have been studied to decrease the pain included different doses of lidocaine (5-9), NSAIDs (5), metoclopramide (6), opiates such as morphine, meperidine, fentanyl (7) tramadol (2), thiopental sodium (4), nafamostatmesilate (10), ketamine (8, 11), ondansetron (12) granisetron (13, 14) magnesium sulfate (8, 15-18) and paracetamol (9, 19), have been associated with different results. "
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    ABSTRACT: 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. 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. 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. 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. 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.
    Full-text · Article · Mar 2014
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    • "The most common side effects of propofol are local pain on injection site as well as blood pressure decline (1). The incidence of propofol pain varies from 28 % to 90% in different studies (2), with a single report of 85% in children (3). The pain can be ranked as severe, an estimate of 5.6 ± 2.3 on VAS pain evaluation system (4). "
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    ABSTRACT: Propofol is one of common anesthetic drugs used in anesthesia. The most common side effects of propofol are local pain. Pretreatment with lidocaine can reduce propofol injection pain. The aim of the present study was to assess and compare the efficiency of lidocaine 0.4% and 2% in reducing the incidence and severity of propofol injection pain. This was a double blind prospective clinical trial on children 4-8 years old with class ASA I and II candidates who were referred to Dr. Shaikh Hospital in Mashhad for elective surgery. Sample size calculated 50 patients in each groups based on pilot study. 100 children's were randomly divided equally in two groups, who were injected with lidocaine solutions 2% and 0.4% respectively. patient's pain evaluation based on VSD (verbal descriptor scale) and NRS (Numeric Rating Scale) using patient's verbal reaction and behavior namely fretting, hand drag and tearing. The collated data was analyzed. There was nosignificant difference as to the first three variables (age, gender and weight P > 0.2). The significant difference regarding pain experience in both groups was noteworthy (P > 0.2). Most of the studies compared lidocaine with other drugs or its efficiency at different doses. Our study is different in that we applied a constant dose of lidocaine in various volumes and concentration. This result shows that lidocaine with the same does but lower concentration and higher volume is more effective in preventing propofol injection pain. Using diluted lidocaine with the dosage of 1 mg/kg and a concentration of 0.4% is an effective way to relieve pain caused by propofol injection in children.
    Full-text · Article · Mar 2014
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    • "Most previous and recent work in this area has been performed on the adjuvant use of hypnotic, analgesic, anti-inflammatory or local anesthetic drugs, which include adding lignocaine to propofol, cooling or warming propofol, diluting the propofol solution, injection of propofol into a large vein and pretreatment with intravenous injection of lignocaine, ondansetron, metoclopramide, opioids, magnesium or thiopentone with or without tourniquet; granisetron, metoclopramide, magnesium, ketorolac, dexamethasone or thiopentone – all have been tried with variable, and sometimes conflicting, results. Several studies have demonstrated the presence of opioid receptors in the primary afferent nerve endings in peripheral tissues.234567891011121314Fentanyl is a short-acting pure opioid agonist commonly used for intraoperative and postoperative systemic analgesia. Also, it has some peripherally mediated analgesic action within the clinical dosage range.[15]Lignocaine is a short-acting local anesthetic agent; when injected into a vein prior to propofol administration, it can reduce pain due to its local anesthetic action.[1,2,16]Pain "
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    ABSTRACT: Propofol (2,6-di-isopropylphenol) used for the induction of anesthesia often causes mild to severe pain or discomfort on injection, for which various methods have been tried, but with conflicting results. The present study involved pretreatment with lignocaine, fentanyl and placebo for prevention of pain on propofol injection to determine the difference in efficacy of fentanyl 100 μg compared with lignocaine 40 mg. Sixty-three participants of either sex, between 18 and 60 years of age, belonging to ASA physical status 1 and 2, undergoing elective surgery under general anesthesia, were randomized into three equal groups of 21 participants. They received, intravenously, either lignocaine (20 mg/mL) or fentanyl (50 μg/mL) or placebo (normal saline 2 mL) pretreatment before the propofol injection. The three groups were comparable with respect to age, height, weight, sex and ASA physical status. The incidences of pain on pretreatment drug injection was higher in the fentanyl group (33.3%) compared with lignocaine and normal saline (P<0.05). The lowest incidence of pain on propofol injection was observed in the lignocaine pretreatment group (14.3%) compared with fentanyl (42.9%) and normal saline (71.4%) (P<0.05). There was no significant difference in adverse skin reaction within groups. In the normal saline pretreatment group, 38.1% of the participants experienced severe pain, compared with 9.5% in the fentanyl (P<0.05) group; none with lignocaine. The number needed to treat was 2 in the lignocaine pretreatment group compared with 4 in the fentanyl pretreatment group. Compared with fentanyl, lignocaine pretreatment was more effective in preventing pain on propofol injection.
    Full-text · Article · Jan 2011
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