How to decrease pain at rapid injection of propofol: effectiveness of flurbiprofen.
OBJECTIVE
Many studies have been conducted on how to decrease propofol injection pain, but none has been completely successful. In the present study, the most effective method was investigated by adding lidocaine or a nonsteroidal antiinflammatory drug or by changing the solvent.


METHODS
A total of 250 patients scheduled for general anesthesia were divided into five groups. Anesthesia was induced with intravenous administration of flurbiprofen 50 mg followed immediately by propofol in a long-chain triglyceride (LCT) 2 mg.kg(-1) (flurbiprofen group, n = 50), flurbiprofen 50 mg followed by propofol LCT 2 mg.kg(-1) 1 min later (flurbiprofen 1 group, n = 50), 2% lidocaine 40 mg followed immediately by propofol LCT 2 mg.kg(-1) (lidocaine group, n = 50), propofol LCT 2 mg.kg(-1) alone (LCT group, n = 50), or propofol in a mixture of medium-chain triglyceride (MCT) and LCT 2 mg.kg(-1) (MCT/LCT group, n = 50). Pain at injection was assessed 10 and 20 s after starting the propofol infusion.


RESULTS
The numbers of patients with severe and mild pain were larger in the order: LCT group (10 and 31 patients, respectively) > flurbiprofen 1 group (3 and 19) > or = MCT/LCT group (1 and 14) > or = lidocaine group (2 and 11) > flurbiprofen group (0 and 0).


CONCLUSIONS
Flurbiprofen 50 mg i.v. just before propofol injection completely abolished propofol injection pain. When it was administered 1 min before propofol injection it was less effective.
Nishiyama
Tomoki
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Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005480:Flurbiprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D011229:Preanesthetic Medication; D015742:Propofol
D000700:Analgesics; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005480:Flurbiprofen; D008012:Lidocaine; D015742:Propofol