title: Bacteriostatic saline containing benzyl alcohol decreases the pain associated with the injection of propofol.
abstract: Bacteriostatic saline is a physiological saline solution containing the bacteriostatic agent benzyl alcohol as a 0.9% solution. It is used mostly for diluting and dissolving drugs for IV injection and as a flush for intravascular catheters. It also has local anesthetic properties. We studied its efficacy in decreasing the pain associated with IV administration of propofol and compared it with mixing lidocaine with propofol. One-hundred-twenty patients were randomly allocated into three groups. All patients received propofol 50 mg. The benzyl alcohol group received bacteriostatic saline as a preinjection, and the lidocaine group received propofol containing lidocaine. The placebo group did not receive bacteriostatic saline or lidocaine. Fifteen of 39 patients (38%) in the benzyl alcohol group complained of pain on injection compared to 33 of 39 (84%) in the placebo group and 22 of 42 (52%) in the lidocaine group. Differences were significant between the benzyl alcohol and placebo groups (P < 0.01) and the lidocaine and placebo groups (P < 0.01). Preinjection with bacteriostatic saline decreases the incidence of pain associated with IV administration of propofol and is comparable to that of mixing lidocaine with propofol.
authors.affiliation: Department of Anesthesia, Vancouver General Hospital and the University of British Columbia, Canada.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Minogue
authors.forename: Deidre A
authors.initials: DA
authors.lastname: Sun
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects*; D019905:Benzyl Alcohol / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D012965:Sodium Chloride / Q000494:pharmacology*
chemical_list: D000779:Anesthetics, Local; D012965:Sodium Chloride; D008012:Lidocaine; D019905:Benzyl Alcohol; D015742:Propofol
references.citation: Briggs L, White M. The effect of premedication on anaesthesia with propofol (Diprivan). Postgrad Med J 1985;61:35–7.
references.citation: Mangar D, Holak EJ. Tourniquet at 50 mm Hg followed by intravenous lidocaine diminishes hand pain associated with propofol injection. Anesth Analg 1992;74:250–2.
references.citation: Doenicke AW, Roizen MF, Rau J, et al. Reducing pain during propofol injection: the role of the solvent. Anesth Analg 1996;82:472–4.
references.citation: Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988;43:492–4.
references.citation: Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991;67:281–4.
references.citation: Picard P, Tramèr M. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000;90:963–9.
references.citation: King SY, Davis FM, Wells JE, et al. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992;74:246–9.
references.citation: Parmar AK, Koay CK. Pain on injection of propofol: a comparison of cold propofol with propofol premixed with lignocaine. Anaesthesia 1998;53:79–83.
references.citation: Lyons B, Lohan D, Flynn C, McCarroll M. Modification of pain on injection with propofol. Anaesthesia 1996;51:394–5.
references.citation: Lee T, Loewenthal A, Strachan J. Pain during injection of propofol: the effect of prior administration of thiopentone. Anaesthesia 1994;49:817–8.
references.citation: Macht DI. A pharmacological and therapeutic study of benzyl alcohol as a local anesthetic. J Pharmacol Exp Ther 1918;11:263–79.
references.citation: Wightman MA, Vaughan RW. Comparison of compounds used for intradermal anesthesia. Anesthesiology 1976;45:687–9.
references.citation: Fein JA, Boardman CR, Stevenson S, et al. Saline with benzyl alcohol as intradermal anesthesia for intravenous line placement in children. Pediatr Emerg Care 1998;14:119–22.
references.citation: Nuttall GA, Barnett MR, Smith RL, et al. Establishing intravenous access: a study of local anesthetic efficacy. Anesth Analg 1993;77:950–3.
references.citation: Bartfield JM, May-Wheeling HE, Raccio-Robak N, et al. Benzyl alcohol with epinephrine as an alternative to lidocaine with epinephrine. J Emerg Med 2001;21:375–9.
references.citation: Martin S, Wilson L. Benzyl alcohol with epinephrine as an alternative local anesthetic. Ann Emerg Med 1999;33:495.
references.citation: Kimura ET, Darby TD, Krause RA, Brondyk HD. Parenteral toxicity studies with benzyl alcohol. Toxicol Appl Pharmacol 1971;18:60-8.
references.citation: Novak E, Stubbs SS, Sanborn EC, Eustice RM. The tolerance and safety of intravenously administered benzyl alcohol in methylprednisolone sodium succinate formulations in normal human subjects. Toxicol Appl Pharmacol 1972;23:54–61.
references.citation: Benzyl alcohol: toxic agent in neonatal units. Pediatrics 1983;72:356–8.
references.citation: Wilson J, Solimando D, Edwards M. Parenteral benzyl alcohol induced hypersensitivity reaction. Drug Intell Clin Pharm 1986;20:689–91.
references.citation: Shmunes E. Allergic dermatitis to benzyl alcohol in an injectable solution. Arch Dermatol 1984;120:1200–1.
references.citation: Hetherington N, Dooley M. Potential for patient harm from intrathecal administration of preserved solutions. Med J Aust 2000;173:141–3.
references.citation: Gehan G, Karoubi F, Quinet A, et al. Optimal dose of lidocaine for preventing pain on injection of propofol. Br J Anaesth 1991;66:324–6.
references.citation: Johnson RA, Harper NJN, Chadwick S. Pain on injection of propofol: methods of alleviation. Anaesthesia 1990;45:439–42.