Prevention of propofol-induced injection pain by sufentanil: a placebo-controlled comparison with remifentanil.
OBJECTIVE
Propofol produces anaesthesia with rapid recovery but also causes pain or discomfort on injection. The effect of remifentanil in prevention of propofol-induced injection pain has been demonstrated in earlier studies. However, sufentanil, an opioid analgesic, has not been evaluated as an agent for managing pain on injection of propofol. In this study we aimed to compare the efficacy of remifentanil and sufentanil for the prevention of propofol-induced pain.


METHODS
This double-blind, placebo-controlled clinical study was carried out from July 2006 to February 2007, and included patients who were candidates for elective surgery in a university hospital. From 92 American Society of Anesthesiologists (ASA) status I-II adult patients, 80 were randomly assigned to four groups of 20 each. Patients received 2 mL of sufentanil 0.01 mg, 2 mL of remifentanil 0.01 mg, 2 mL of remifentanil 0.02 mg, or 2 mL of saline 60 seconds prior to administration of 5 mL of propofol 1%. Patients were asked prior to losing consciousness whether they felt any pain due to propofol injection, and their pain scores were evaluated on the four-point scale of Ambesh et al.


RESULTS
The incidence of pain was significantly lower in the remifentanil 0.02-mg group, remifentanil 0.01-mg group and sufentanil group compared with the saline group (40%, 70%, 75% and 100%, respectively, p < 0.05). Median pain intensity scores were significantly lower in the group receiving remifentanil 0.02 mg than in the sufentanil group (0 and 1 respectively, p < 0.05). The median intensity of propofol-induced pain was statistically similar between the groups receiving sufentanil or remifentanil 0.01 mg and the placebo group (1, 1 and 1, respectively, p > 0.05).


CONCLUSIONS
Remifentanil 0.02 mg administered over 60 seconds before propofol administration is more effective than sufentanil 0.01 mg, remifentanil 0.01 mg or placebo administered 1 minute prior to propofol in reducing the incidence and intensity of injection pain.
Honarmand
Azim
A
Department of Anaesthesiology and Intensive Care Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Safavi
Mohammadreza
M
D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007275:Injections, Intravenous / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010919:Placebos; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D000077208:Remifentanil; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D010919:Placebos; D017409:Sufentanil; D000077208:Remifentanil; D015742:Propofol