Prevention of pain on injection of propofol: systematic review and meta-analysis

Objective: To systematically determine the most effective method for preventing pain from propofol injection

Data sources PubMed, Embase, Cochrane Library, www.clinicaltrials.gov, manual search from the list of identified papers

Randomized controlled trials that selected studies comparing drug and non-drug interventions to placebo or other interventions to reduce propofol pain in adults

The results are from 177 randomized controlled trials covering a total of 25 260 adults. The overall risk of pain by propofol injection alone is about 60%. Using the anterior elbow vein instead of the hand vein was the most effective single intervention (relative risk 0.14, 95% confidence interval 0.07 to 0.30). Pretreatment with lidocaine (lidocaine) and venous occlusion was equally effective (0.29, 0.22 to 0.38). Other effective interventions were lidocaine-propofol mixture (0.40, 0.33 to 0.48), lidocaine (0.47, 0.40 to 0.56), opioid (0.49, 0.41 to 0.59), and ketamine (0.52, 0. 46 to 0.58) . 0.57) or non-steroidal anti-inflammatory drug (0.67, 0.49 to 0.91); and propofol emulsion containing medium chain and long chain triglycerides (0.75, 0. 67 to 0 .84). Statistical testing of indirect comparisons showed that the use of the anterior elbow vein, the preconditioning of lidocaine and the use of venous occlusion were more effective than the other interventions.

Conclusion The two most effective interventions to alleviate the pain of injection of propofol are the use of the anterior elbow vein when choosing a vein of the hand or pretreatment with lidocaine and vein occlusion. Under the independent efficacy assumption, a third practical alternative would be to pretreat the vein of the hand with lidocaine or ketamine and to use a propofol emulsion containing medium chain and long chain triglycerides . Although it is not the most effective intervention, it is usually advisable unless contraindicated, because using a small amount of opioid before introduction can reduce the risk of injection pain.

Injection pain is a disadvantage of propofol long chain triglyceride (LCT) and reduces patient satisfaction. According to a systematic review, the recommended way to relieve this pain is to give lidocaine for 30 to 120 seconds under the tourniquet before propofol injection (lidocaine pretreatment). Recently propofol medium chain triglyceride / long chain triglyceride (MCT / LCT) emulsion has been proposed for their ability to reduce the risk of injection pain. The authors conducted a double-blind randomized controlled trial comparing the incidence and severity of pain by propofol LCT injection before and after propofol MCT / LCT and propofol pretreatment.

Pain during injection of propofol: combination of propofol LCT and propofol MCT / LCT or without lidocaine pretreatment

Background: Propofol injection pain is considered a problem during clinical anesthesia. A systematic review of the effects of lidocaine on pediatric pain relief has not been determined. The purpose of this study was to systematically evaluate the effectiveness and safety of this intervention. Method: The literature search was conducted on May 31, 2016 in the PubMed, Ovid EMBASE and Cochrane databases. Lidocaine was used in all randomized controlled trials to treat pain in children with propofol injection. The main results were the incidence of injection pain and the incidence of propofol injection pain. Combining the data, we calculated the relative ratio and its associated 95% confidence interval. Meta analysis based on Cochrane Reviewer's Handbook and PRISMA Statement

Effectiveness of lidocaine in prevention of incidence and severity of propofol related pain in children: meta-analysis of randomized controlled trials according to PRISMA criteria