title: Pain on injection: a double-blind comparison of propofol with lidocaine pretreatment versus propofol formulated with long- and medium-chain triglycerides.
abstract: The incidence of pain on injection of propofol has been reported to be 70%. A new propofol formulation with a 10% emulsion of long- and medium-chain triglycerides (LCT/MCT) is associated with less pain on injection. Our goal was to compare the effect of propofol-LCT/MCT on the incidence of pain versus propofol with lidocaine 40 mg IV pretreatment injected as a Bier's block. Two hundred healthy women scheduled for ambulatory gynecological procedures were allocated to 1 of 2 groups in a randomized double-blind fashion. Group LIDO received lidocaine 2% 2 mL injected with a tourniquet 1 min before propofol 1% 2 mg/kg IV; group LCT/MCT received NaCl 0.9% 2 mL with tourniquet 1 min before propofol-LCT/MCT 1% 2 mg/kg IV. Spontaneous verbal expressions of pain, movement of hand, frowning, and moaning during the injection were recorded. The incidence and severity of pain were assessed 30 min and 6 h after surgery. Recall of pain was considered with a visual analog scale (VAS) score >1, and pain was graded as VAS 0-10. More women reported spontaneous verbal expression of pain with propofol-LCT/MCT (47% versus 24%; P = 0.0014; relative risk 1.61 [95% confidence interval, 1.22-2.13]). Among women with a painful injection, there was no difference after surgery regarding the intensity of pain or recall of pain. In contrast to previous reports, we found that propofol-LCT/MCT resulted in a more frequent incidence of pain than propofol 1% with IV lidocaine pretreatment. This may be due to the diversity of pain definitions used in studies or to the lack of premedication in our study.
authors.affiliation: Service d'Anesthésiologie, Département d'Anesthésiologie, Pharmacologie et Soins Intensifs de Chirurgie (APSIC), Hôpitaux Universitaires de Genève, Switzerland.
authors.forename: E
authors.initials: E
authors.lastname: Schaub
authors.forename: C
authors.initials: C
authors.lastname: Kern
authors.forename: R
authors.initials: R
authors.lastname: Landau
mesh_terms: D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002626:Chemistry, Pharmaceutical; D004311:Double-Blind Method; D005079:Excipients; D005227:Fatty Acids; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D011939:Mental Recall; D010146:Pain / Q000139:chemically induced / Q000517:prevention & control*; D010147:Pain Measurement / Q000187:drug effects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*; D014280:Triglycerides
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005079:Excipients; D005227:Fatty Acids; D014280:Triglycerides; D008012:Lidocaine; D015742:Propofol