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A898
October 16, 2006 9:00 AM - 11:00 AM Room Hall E, Area E |
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| Pain on Injection of Propofol: The Effect of Injectate Temperature and Injection Speed | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Takeru Shimizu, M.D., Shinichi Inomata, M.D., Shigeyuki Saito, M.D., Masayuki Miyabe, M.D., Makoto Tanaka, M.D. Department of Anesthesiology, University of Tsukuba, Tsukuba, Ibaraki, Japan |
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Background: A major disadvantage of propofol administration is pain on injection. Pre-treatment with lidocaine, opioids, metoclopramide, ephedrine, magnesium sulphate, neostigmine, ketoralac and injection into a large vein have all been reported to reduce the incidence and severity of pain. We have previously reported that rapid injection (5 ml/sec) of cold propfol (5 degrees C) also reduces pain as compared with slow injection (0.33 ml/sec). So far the effect of combination of injectate temperature and injection speed has not been well studied. Therefore we conducted the following study. Patients and Methods: A double-blind, randomized clinical study was undertaken to compare the effect of temperature and speed on the incidence and severity of the pain experienced on injection of propofol. Two hundred patients (ASA I-III, aged 7-85) who presented for elective surgery were allocated into the following 6 groups. Cold slow group (CS): 5 degrees C, 0.33 ml/sec Cold rapid group (CR): 5 degrees C, 5 ml/sec Warm slow group (WS): 42 degrees C, 0.33 ml/sec Warm rapid group (WR): 42 degrees C, 5 ml/sec Room temperature slow group (RTS): 22-25 degrees C, 0.33 ml/sec Room temperature rapid group (RTR): 22-25 degrees C, 5 ml/sec All patients were given propofol 2 mg/kg. An observer blinded to the pre-treatment and infusion rate evaluated the pain using a 4-point scale. Ephedrine was administered if systolic blood pressure was 30% lower than baseline values. Results: Demographic data were similar among the groups. Rapid injection of cold propofol was less painful than slow injection of cold or room-temperature propofol. Slow injection of warm propofol was also less painful than slow injection of room-temperature propofol, and was similar to rapid injection of cold propofol. Rapid injection of warm propofol did not reduce pain. No patient required ephedrine. Discussion: We found that pain was reduced by rapid injection of cold propofol, which was as effective as well-established lidocaine pretreatment. It was compatible with our previous report. However, rapid injection of warm propofol did not reduce pain significantly. The exact mechanism for the production of pain with propofol injection remains to be elucidated. The activation of the kinin cascade has been suggested. Temperature or speed may affect to stabilize the kinin cascade, though further research is required. Conclusion: We conclude that both rapid injection of cold propofol and slow injection of warm propofol reduce pain without any pretreatment. These methods could be an alternative to reduce both allergic risks and medical costs.[table1] Anesthesiology 2006; 105: A898 |
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