Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study.
BACKGROUND
Pain on injection limits the use of propofol in children. The combination of lidocaine and propofol is widely used to reduce pain. A new solvent [medium-chain triglyceride (mct)/long-chain triglyceride (lct)] has been advocated to be less painful than standard (lct) propofol in adults, but no information is available of its usefulness in pre-school children. We designed a prospective, randomized, double-blinded, placebo-controlled study to assess injection pain with two different propofol emulsions, each given with or without lidocaine in children <7 yr.


METHODS
A total of 160 ASA I-III children were randomly assigned to receive lct-propofol or mct/lct-propofol, 5 mg kg(-1), with lidocaine 10 mg ml(-1) or saline. The site and size of venous cannulation and restlessness before injection were recorded in each patient. A pain score graded 0-6 was established based on spontaneous verbal and motor reaction during injection, each graded 0-3. Kruskall-Wallis and Mann-Whitney tests were used for statistical analysis.


RESULTS
Median pain scores decreased in all groups compared with lct-propofol-saline (P<0.001) and were least in the lct/mct-propofol-lidocaine group (P<0.001). Painless injection (score, 0-2) occurred in 92.5% of patients in the mct/lct-propofol-lidocaine group compared with 41-77% in the others (P<0.001).


CONCLUSIONS
Mct/lct-propofol caused significantly less pain than lct-propofol in preschool children. Mixing of lidocaine with mct/lct-propofol resulted in a further significant decrease, virtually eliminating the pain on injection.
Department of Anaesthesia and Intensive Care A, Hôpital Lapeyronie, Montpellier, France. a-rochette@chu-montpellier.fr
A
A
Rochette
A F
AF
Hocquet
C
C
Dadure
D
D
Boufroukh
O
O
Raux
J F
JF
Lubrano
S
S
Bringuier
X
X
Capdevila
D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local; D002626:Chemistry, Pharmaceutical; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous / Q000009:adverse effects; D008012:Lidocaine; D008297:Male; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D014677:Pharmaceutical Vehicles; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012997:Solvents
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014677:Pharmaceutical Vehicles; D012997:Solvents; D008012:Lidocaine; D015742:Propofol