title: Lidocaine for prevention of propofol injection-induced pain: A prospective, randomized, double-blind, controlled study of the effect of duration of venous occlusion with a tourniquet in adults.
abstract: BACKGROUND
  Many patients experience pain on injection of propofol. The use of lidocaine to prevent propofol injection pain is common. The analgesic effect of pre-injected lidocaine has been found to increase when a tourniquet is used.
  
  
  OBJECTIVE
  The aim of this study was to compare the effectiveness of various venous occlusion times with lidocaine analgesia to prevent pain during propofol injection.
  
  
  METHODS
  In this prospective, randomized, double-blind, controlled study, women aged 18 to 45 years, classifed as American Society of Anesthesiologists physical sta- tus I or II, who were scheduled to undergo elective surgery under general anesthesia induced with propofol, were randomly assigned to 1 of 5 groups: group 1, 2% lidocaine 20 mg in saline in a total volume of 10 mL and no venous occlusion; group 2, 2% lidocaine 20 mg in saline in a total volume of 10 mL plus venous occlusion for 15 seconds; group 3, 2% lidocaine plus venous occlusion for 30 seconds; group 4, 2% lidocaine plus venous occlusion for 60 seconds; and group 5, saline 10 mL and no venous occlusion. When the first 25% of the calculated propofol dose was administered, patients were asked about propofol-induced pain using a verbal pain scale (0 = no pain; 1 = mild pain; 2 = moderate pain; and 3 = severe pain). All patients and the anesthesiologist who evaluated pain severity were blinded to the study preparation being used.
  
  
  RESULTS
  The study comprised 100 women who were randomly divided into 5 groups of 20 patients each. Significantly more patients in group 5 (18 [90%] patients; P < 0.05) reported pain compared with the other treatment groups. In groups 2, 3, and 4, in which venous occlusion was applied, pain was reported during propofol injection in 6 (30%), 7 (35%), and 2 (10%) patients, respectively. The incidence of reported pain was significantly greater in group 1 (lidocaine without venous occlusion) than in group 4 (P < 0.05); however, the incidence of pain was similar in group 1 compared with groups 2 and 3.
  
  
  CONCLUSIONS
  The present study found that pretreatment with lidocaine 20 mg with or without venous occlusion significantly reduced the incidence and the severity of pain during the injection of propofol when compared with the group with no venous occlusion administered saline. In addition, pretreatment with lidocaine 20 mg plus venous occlusion for 60 seconds significantly reduced the incidence of propofol-induced pain compared with lidocaine without venous occlusion.
authors.affiliation: Department of Anaesthesiology and Reanimation, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
authors.forename: Sedat
authors.initials: S
authors.lastname: Kaya
authors.affiliation: Department of Anaesthesiology and Reanimation, Mustafa Kemal University Faculty of k4edicine, Hatay, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Turhanoglu
authors.affiliation: Department of Anaesthesiology and Reanimation, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
authors.forename: Haktan
authors.initials: H
authors.lastname: Karaman
authors.affiliation: Department of Anaesthesiology and Reanimation, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
authors.forename: Sule
authors.initials: S
authors.lastname: Ozgün
authors.affiliation: Department of Anaesthesiology and Reanimation, Dicle University Faculty of Medicine, Diyarbakir, Turkey.
authors.forename: Nihal
authors.initials: N
authors.lastname: Basak
keywords: complication; intravenous anesthetic; lidocaine; local anesthetic; pain; propofol; venous occlusion