Abstract
Background and Aims: Propofol is considered as an ideal induction agent for General anaesthesia. However no drug or technique could effectively alleviate the pain on its injection. In the present study we compared the efficacy of pre-treatment with Lignocaine and Ondansetron in reducing the incidence and severity of Propofol induced pain and their safety profile.
Materials and Methods: We included 200 patients with American society of Anaesthesiologists (ASA) grade I & II between the age group 18 to 65 years undergoing elective surgery under general anaesthesia. Pain during Propofol injection was compared between Lignocaine 1.5 mg/kg and Ondansetron 0.1mg/kg. Pain was assessed using four point scale (FPS) and numerical rating scale (NRS). The association between categorical variables were done using Chi-square or Fisher’s exact test. Continuous variables following normality were assessed using Student’s t-test and for non-normal variables Mann Whitney U test was used. A p-value <0.05 was considered as significant.
Results: About 80% of patients in either of the groups didn’t have pain on Propofol injection. Both the drugs were found to be equally effective in reducing the incidence of pain, and intensity was found comparable. But the pain due to injection of Ondansetron itself was found to be significant compared to Lignocaine (p-value <0.001) along with rash appearing at the site of injection (p-value 0.003).
Conclusion: Though both the drugs were found equally effective in reducing the incidence of Propofol induced pain, Lignocaine was found to have a better safety profile than Ondoansetron comparing their side effects.
Keywords: General Anaesthesia; Pain; Propofol; Lignocaine; Ondansetron
References
- Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ 2011;342:d1110.
- Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90(4):963-9.
- Singh D, Jagannath S, Priye S, Shivaprakash, Kadli C, Reddy D. Prevention of propofol injection pain: Comparison between lidocaine and ramosetron. J Anaesthesiol Clin Pharmacol 2014;30(2):213-6.
- Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: A comparison of lidocaine with alfentanil. Anesth Analg 1996;82(3):469-71.
- Vijayant GA, Tej KK, Avtar S, Anju G, Rupinder MS, Daljit KK. Analgesic effect of Lignocaine, tramadol, ketorolac and ketoprofen in ameliorating Propofol injection pain. J Anaesthesiol Clin Pharmacol 2005;21(4): 89-93.
- Swaika S, Pal A, Chatterjee S, Saha D, Dawar N. Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy? Anesth Essays Res. 2011;5(2):182-6. doi: 10.4103/0259-1162.94761.
- Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. A comparison of their pharmacology and clinical efficacy. Drugs 1998;55(2):173-89.
- Ye JH, Mui WC, Ren J, Hunt TE, Wu WH, Zbuzek VK. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg 1997; 85(5):1116-21.
- Rahimzadeh P, Faiz SH, Nikoobakht N, Ghodrati MR. Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial. Adv Biomed Res 2015;4:56. doi: 10.4103/2277-9175.151593. eCollection 2015.
- Ansari MU, Garg G, Lodha LR, Qureshi SU, Porwal S. Pretreatment with intravenous Ondansetron to alleviate pain on Propofol injection. A randomized controlled and double blind study. J of pharm Biomed Sci 2013;32:1274-78.
- Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998; 53(5):468-76.
- Tariq MA, Kamran M. Incidence of pain on Propofol injection and efficacy of addition of Lignocaine selecting big vein or both combined in reducing it. J of post graduate medical institute 2006;20:8-11.
- Hwang J, Park HP, Lim YJ, Do SH, Lee SC, Jeon YT. Preventing pain on injection of propofol: a comparison between peripheral ketamine pre-treatment and ketamine added to propofol. Anaesth Intensive Care 2009; 37(4):584-7.
- Ishiyama T, Kashimoto S, Oguchi T, Furuya A, Fukushima H, Kumazawa T. Clonidine-ephedrine combination reduces pain on injection of propofol and blunts hemodynamic stress responses during the induction sequence. J Clin Anesth 2006; 18(3):211-5.
- He L, Xu JM, He T, Liu L, Zhu R. Dexmeditomidine pre-treatment alleviates propofol injection pain. Ups J Med Sci 2014;119(4):338-42. doi: 10.3109/03009734.2014.941049. Epub 2014 Oct 24.
- Shivanna S, Priye S, Singh D, Jagannath S, Mudassar S, Reddy DP .Efficacy of methylprednisolone and lignocaine on propofol injection pain: A randomised double-blind prospective study in adult cardiac surgical patients. Indian J Anaesth 2016;60(11):848-851.
- Eriksson M, Englesson S, Niklasson F, Hartvig P. Effect of lignocaine and pH on Propofol induced pain. Br J Anaesth 1997;78(5):502-6.
- Nishiyama T. How to decrease pain at rapid injection of propofol: effectiveness of flurbiprofen. J Anesth 2005;19(4):273-6.
- Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988 Jun;43(6):492-4.
- Gehan G, Karoubi P, QuinetF, Leroy A, Rathat C, Pourriat JL. Optimal dose of lignocaine for preventing pain on injection of propofol. Br J Anaesth 1991;66(3):324-6.
- King SY, Davis FM, Wells JE, Murchison DJ, Pryor PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992;74(2):246-9.
- Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: A randomized controlled double blinded study. Anesth Analg 1999;89(1):197-9.
- Dubey PK, Prasad SS. Pain on injection of propofol: the effect of granisetron pretreatment. Clin J Pain 2003;19(2):121-4.
- El-Radaideh KM. Effect of pre-treatment with lidocaine, intravenous paracetamol and lidocaine-fentanyl on propofol injection pain. Comparative study. Rev Bras Anestesiol 2007;57(1):32-8.
- Sunny A, Veerabhadraiah T, TrivikramS. Comparison of pretreatment with lignocaine and Ondansetron for pain on injection of propofol during induction of anaesthesia. Internet J Anesthesiol 2013;32:1373–6.
- Preetha R, Archana BN. To compare the efficacy of intravenous pre treatment with Injection Ondansetron 4mg and Injection Lignocaine 40 mg preceded by venous occlusion for reducing pain on injection of Propofol in adult surgical patients. Asian J Biochem and pharmac Research 2014;4:(3) 161-8.
- Prashant J, Pachore, Sonal A, Chaudhari, Abhimanyu S, Tarkase, Ganesh K, Nikam. Comparative Study of Ondansetron with Lignocaine to alleviate pain during injection of propofol. J evolution of medical and dental sciences. 2014;31:10828-35.
- Reddy MS1, Chen FG, Ng HP. Effect of Ondansetron pretreatment on pain after rocuronium and propofol injection: a randomised, double-blind controlled comparison with lidocaine. Anaesthesia. 2001;56(9):902-5.
Corresponding Author
Dr Venugopal A
Additional Professor in Anaesthesiology, Regional Cancer Centre, Thiruvanathapuram, Kerala,
India Pin: 695011