Comparative Study on the Effectiveness of Granisetron and Metoclopramide for Reducing Propofol Injection Pain

Title: Comparative Study on the Effectiveness of Granisetron and Metoclopramide for Reducing Propofol Injection Pain

Authors: Dr Aravind Johnson, Dr Harikrishnan S, Dr Radhika Devi B

DOI: https://dx.doi.org/10.18535/jmscr/v5i4.163

Abstract

Background: Propofol is one of the widely used intravenousanaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. The aim of my randomized double blinded study was to compare the effectiveness of Granisetron and Metoclopramide in reducing Propofol injection pain. Both these drugs are used as anti emetic drugs. This study also compares the effectiveness of Granisetron and Metoclopramide in reducing post operative nausea and vomiting.

Methods: 760 patients, aged 21-50 years ,American society of Anaesthesiologists grading (ASA) 1-2, scheduled for various surgeries under general anaesthesia were randomly assigned to one of two groups (380 in each group) . One group (Group A) received 2ml Granisetron (1mg/ml) while the other group (Group B) received 2ml Metoclopramide (5mg/ml) and were accompanied by manual venous occlusion for one minute. Then 2ml Propofol was injected through the same cannula. Patients were asked by a blinded anaesthesiologist to score pain on injection of Propofol with a four point scale (VRS-Verbal Rating Scale) : 0= no pain, 1= mild pain, 2=moderate pain, 3=severe pain. The Post operative nausea/vomiting was assessed by Visual Analog Scale (0=no symptoms , 10=worst symptoms)

Results: 65 patients (17.1%) complained of pain in group pretreatedwith Granisetron that is 31 patients (8.1%) with mild pain (VRS 1), 20 patients (5.3%) with moderate pain (VRS 2), 14 patients (3.7%) with severe pain (VRS 3). 151 patients (39.7%) complained of pain in group pretreated with Metoclopramide that is is 76 patients (20%) with mild Pain (VRS 1), 57 patients (15%) with moderate pain (VRS 2) , 18 patients (4.7%) with severe pain (VRS 3). The presence and severity of pain was less in the Granisetron group compared with Metoclopramide group (P< 0.05 ).

In Granisetron group, 41 patients (10.8%) complained of post operative nausea /vomiting that is 38 (10%) had VAS score 1, 2 (0.5%) had VAS score 2, 1 (0.3%) had VAS score 1. In Metoclopramide group, 112 patients (29.5%) complained of post operative nausea /vomiting that is 76 (20%) had VAS score 1, 19 (5%) had VAS score 2, 17 (4.5%) had VAS score 3. The presence and severity of post operative nausea and vomiting was less in the Granisetron group compared with Metoclopramide group (P<0.05).

Conclusion: Intravenous Granisetron at a dose of 2mg was moreeffective than intravenous Metoclopramide at a dose of 10 mg along with manual occlusion for one minute in reducing Propofol injection pain when given before propofol injection. Also, Granisetron was more effective than Metoclopramide in reducing post operative nausea and vomiting.

References

1. Smith I, White PF, Nathanson M, Goul-dson R. Propofol: An update on its clinical use. Anesthesiology 1994;81:1005-43.

2. Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesia-ologists. Anesth Analg 1999;88:1085-91.

3. Hynynen M, Korttila K, Tammisto T. Pain on IV injection of propofol (ICI 35868) in emulsion formulation: Short communi-cation. Acta Anaesthesiol Scand 1985;29: 651-2.

4. King SY, Davis FM, Wells JE, Murchinson DJ, Pryor PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992;74:246-9.

5. McCrirrick A, Hunter S. Pain on injection of propofol: The effect of injectate temperature. Anaesthesia 1990;45:443-4.

6. Stokes DN, Robson N, Hutton P. Effect of diluting propofol on the incidence Of pain on injection and venous sequelae. Br J Anaesth 1989; 62:202-3.

7. McCulloch MJ, Lees NW. Assessment and modification of pain on injection with propofol (Diprivan). Anaesthesia 1985; 40:1117-20.

8. Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: A randomized, controlled, double-blind study. Anesth Analg 1999;89:197-9.

9. Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia1998;53:296-304.

10. Agarwal A, Ansari MF, Gupta D, Pandey R, Raza M, Singh PK, et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg 2004;98:683-6.

11. Liaw WJ, Pang WW, Chang DP, Hwang MH. Pain on injection of propofol: The mitigating influence of metoclopramide using different techniques. Acta Anaesthesiol Scand 1999;43:24-7.

12. Fletcher JE, Seavell CR, Bowen DJ. Pretreatment with alfentanil reduces pain caused by propofol. Br J Anaesth 1994;72:342-4.

13. Liljeroth E, Karlsson A, Lagerkranser M, Akeson J. Low dose propofol reduces the incidence of moderate to severe local pain induced by the main dose. Acta Anaesthesiol Scand 2007;51:460-3.

14. Mangar D, Holak EJ. Tourniquet at 50 mmHg followed by intravenous lidocaine diminishes hand pain associated with propofol injection. Anaesth Analg 1992;74:250-15.

15. Valtonen M, Lisalo E, Kanto J, Rosenberg P. Propofol as an induction agentin children: Pain on injection and pharmacy-okinetics. Acta Anaesthesiol Scand 1989;33:152-5.

16. Scott RP, Sunders DA, Norman J. Propofol: Clinical strategies for preventing the pain on injection. Anaesthesia 1988;43 :492-4.

17. Mattila MA, Koski EM. Venous sequelae after intravenous propofol: A comparison with methohexitone in short anaesthesia. Postgrad Med J 1985;61:162-4.

18. King SY, Davis FM, Wells JE. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg 1992;74:246-9.

19. Johnson RA, Harper NJ, Chadwick S, Vohra A. Pain of injection of propofol: Methods of alleviation. Anaesthesia 1990;45:439-42.

20. McCrirrick A, Hunter S. Pain on injection of propofol: The effect of injectate temperature. Anaesthesia 1990;45:443-4.

21. Barker P, Langton JA, Murphy P, Rowbotham DJ. Effect of prior administration of cold saline on pain during propofol injection: A comparison with cold propofol and propofol with lignocaine. Anaesthesia 1991;46:1069-70.

22. Klement W, Arndt JO. Pain on injection of propofol: Effects of concentration and diluent. Br J Anaesth 1991;67:281-4.

23. Dolin SJ, Cashman JN, Bland JM: Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J naesth 2002; 89:409-423.

24. Palazzo M, Evans R: Logistic regression analysis of fixed patient factors For postoperative sickness: A model for risk assessment. Br J Anaesth 1993; 70:135-140.

25. Cohen MM, Duncan PG, DeBoer DP, Tweed WA: The postoperative interview: Assessing risk factors for nausea and vomiting. Anesth Analg 1994; 78:7-16.

26. Koivuranta M, Laara E, Snare L, Alahuhta S: A survey of postoperativenausea and vomiting. Anaesthesia 1997; 52:443-449.

27. Apfel CC, Laara E, Koivuranta M, et al: A simplified risk score for predicting postoperative nausea and vomiting: Concl-usions from cross-validations between two centers. Anesthesiology1999; 91:693-700.

28. Eberhart LHJ, Hogel J, Seeling W, et al: Evaluation of three risk scores to predict postoperative nausea and vomiting. ActaAnaesthesiol Scand 2000; 44:480-488.

29. Visser K, Hassink EA, Bonsel GJ, et al: Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: Postoperative nausea with vomiting and economic analysis. Anesthesiology 2001; 95:616-626.

30. Stadler M, Bardiau F, Seidel L, et al: Difference in risk factors for postoperative nausea and vomiting. Anesthesiology 2003; 98:46-52.

31. Watcha MF, White PF: Postoperative nausea and vomiting: Its etiology, treatment, and prevention. Anesthesiology 1992; 77:162-184.

32. Macario A, Weinger M, Carney S, Kim A: Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999; 89:652-658

33. Darkow T, Gora-Harper ML, Goulson DT, Record KE: Impact of antiemetic selection on postoperative nausea and vomiting and patient satisfaction. Pharmacotherapy 2001; 21:540-548.

34. Bremner WG, Kumar CM: Delayed surgical emphysema, pneumomediastinum and bilateral pneumothoraxes after postoperative vomiting. Br J Anaesth 1993; 71:296-297.

35. Schumann R, Polaner DM: Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg 1999; 89:796-797.

36. Gold BS, Kitz DS, Kecky JH, Neuhaus JM: Unanticipated admission to the hospital following ambulatory surgery. JAMA 1989; 262:3008-301

37. Ye JH, Mui WC, Ren J, Hunt TE, Wu WH, Zbuzek VK. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg 1997;85:1116-21.

38. Desmond PV, Watson KJ. Metoclop-romide- a review. Med J Aus1986; 144:366-9

39. Albibi R, McCallum RW. Metoclopr-omide-Pharmacology and clinical application. Ann Int Med 1983;93:86-95.

40. Mecklem DW. Propofol injection pain: Comparing the addition of lignocaine or metoclopramide. Anaesth Intensive Care 1994;22:568-70.

41. Stark RD, Binks SM, Dutka VN, O'Connor KM, Arnstein MJ, Glen JB.: A review of the safety and tolerance of propofol ('Diprivan'):Postgraduate Medical Journal 1985;61 Suppl 3:152-6.

42. Nightingale P, Healy E, Hargreaves J, McGuiness K, Kay B. Propofol in emulsion form: induction characteristics and venous sequelae. Eur J Anaesthesiol 1985; 2: 361-8.

43. Marcario A, Weinger M, Truong P, Lee M. Which clinical anesthesiaoutcomes are both common amd important to avoid? The perspective of a panel of expert anesthes-iologists. AnesthAnalg 1999; 88: 1085-91.

44. Tan CH, Onsiong M. Pain on injection of propofol. Anaesthesia 1998; 53: 468-76.

45. Eriksson M, Englesson S, Niklasson F, Hartvig P. Effect of lignocaine and pH on propofol-induced pain. Br J Anaesth 1997; 78: 502-6.

46. Doenicke A, Roizen M, Rau J, Kellerman W, Babl J. Reducing pain during propofol injection: The role of the solvent. AnesthAnalg 1996; 82: 472-4.

47. Doenicke A, Roizen M, Rau J et al. Pharmacokinetics and pharmacodynamics of propofol in a new solvent. Anesth Analg 1997; 85: 1399-1403

48. Nishiyama T. How to decrease pain at rapid injection of propofol: effectiveness of flurbiprofen. J Anesth 2005; 19: 273-6.

49. Ohmizo H, Obara S, Iwama H. Mechanism of injection pain with long- and long-medium chain triglyceride emulsive propofol. Can J Anaesth 2005; 52: 595-9.

50. Ando R, Watanabe C. Characteristics of propofol-evoked vascular pain in anaesth-etized rats. Br J Anaesth 2005; 95: 384-92.

51. Song D, Hamza M, White P, Byerly S, Jones S, Macaluso A. Comparison of a lower-lipid propofol emulsion with the standard emulsion for sedation during monitored anesthesia care. Anesthesiology 2004; 100: 1072-5.

52. Sosis MB, Braverman B. Grouth of staphylolcoccus aureus in four intravenous anesthetics. Anesth Analg 1993; 77: 766-8.

53. Sosis M, Braverman B, Villaflor E. Propofol but not thiopental supports the growth of candida albicans. Anesth Analg 1995; 81:132-4.

54. Ozer Z, Ozturk C, Altukan A, Cinel I, Oral U. Inhibition of bacterial growth by lignocaine in propofol emulsion. Anaest-hesia Intensive Care 2002; 30: 179-82.

55. Dubey P, Kumar A. Pain on injection of lipid-free propofol and propofol emulsion containing medium-chain triglyceride; A comperative study. Anesth Analg 2005; 101: 1060-2.

56. Fechner J, Ihmsen H, Hatterscheid D et al. Pharmacokinetics and clinical pharmacod-ynamics of the new propofol prodrug GPI 15715 in volunteers. Anesthesiology 2003; 99: 303-13.

57. McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate tempe-rature. Anaesthesia 2005; 45: 1090-1.

58. Yamakage M, Iwasaki S, Satoh J-I, Namiki A. Changes in concentration of free propofol by modification of the solution.Anesth Analg 2005; 101: 385-8.

59. Picard P, Tramér M. Prevention on injection with propofol: A quantitative systematic review. Anesth Analg 2000; 90: 963-9.

60. Klement W, Arndt JO. Pain on injection of propofol. Effects of concentration and diluent. Br J Anaesth 1991; 67: 281-4.

61. Huang CL, Wang Y, Cheng YJ, Susetio L, Liu CC. The effect of carrier intravenous fluid speed on the injection pain of propofol. Anesth Analg 1995;81: 1087-8.

62. Huang YW, Buerkle H, Lee TH et al. Effect of pretreatment with ketorolac on propofol injection pain. Acta Anaesthesiol Scand2002; 46: 1021-4.

63. Angst M, MS , Zupfer H, Tatanu C, Brock-Utne J. Reduction of propofol injection pain with a double lumen iv set. J Clin Anesth 1997; 9: 462-6.

64. McDonald DS, Jameson P. Injection pain with propofol: Reduction with aspiration of blood. Anaesthesia 1996; 51: 878-80.

65. Davies AF, Vadodaria B, Hopwood B, Dexter T, Conn D. Efficacy of microfiltration in decreasing propofol-induced pain.Anaesthesia 2002; 57: 557-61

66. Hellier C, Newell S, Barry J, Brimacombe J. A 5-microm filter does not reduce prop-ofol-induced pain. Anaesthesia 2003; 58: 802-3.

67. Finkelstein A, Lokhandwala B, Pandey NS. Particulate contamination of an intact glass ampoule. Anesthesiology 1990;362-3.

68. Lomax D. Propofol injection pain. Anaesth Intensive Care 1994; 22: 500-1.

69. Seki S, Sekine R, Aketa K et al. Induction of anesthesia with propofol through a central venous catheter. Masui 1999; 48: 62-6

70. Shimizu T, Inomata S, Kihara S, Toyooka H, Brimacombe JR. Rapid injection reduces pain on injection with propofol. Eur Jnaesthesiol 2005; 22: 394-6.

71. Ahmed A, Sengupta S, Das T, Rudra A, Iqbal A. Pre-treatment with intravenous Granisetron to alleviate pain on propofol injection: A double blind, randomised, controlled trial. Indian J Anaesth. 2012;56:135-8.

72. Dhananjay Kumar Singh, Parul indal, and Gaurav Singh Comparative study of attenuation of the pain caused by propofol intravenous injection, by Granisetron, magnesium sulfate and nitroglycerine Saudi J Anaesth. 2011 Jan-Mar; 5(1): 50–54.

73. Dubey PK, Prasad SS. Pain on injection of propofol: the effect of Granisetron pretreatment. Clin J Pain. 2003 Mar-Apr;19(2):121-4

74. Zahedi H, Maleki A, Rostami G. Ondansetron pretreatment reduces pain on injection of propofol. Acta Med Iran 2012;50:239-43.

75. Piper SN, Röhm KD, Papsdorf M, Maleck WH, Mattinger P, Boldt J. Dolasetron reduces pain on injection of propofol. Anasthesiol Intensivmed Notfallmed Schmerzther 2002;37:528-31.

76. Dipali Singh, Sathyanarayan Jagannath, Shio Priye, Sivaprakash, Chandrashekar kadli, Durgaprasad Reddy Prevention of propofol injection pain: Comparison between lidocaine and ramosetronJ Anaesthesiol Clin Pharmacol. 2014 Apr-Jun; 30(2): 213–216.

77. Reyhan Polat Meltem Aktay, Onur Özlü The effects of remifentanil, lidocaine metoclopramide, or ketamine pretreatment on propofol injection pain M.E.J. anesth 21 (5), 2012.

78. Fujii Y¹, Uemura A. Effect of metoclopramide on pain on injection of propofol. Anaesth Intensive Care. 2004 Oct;32(5):653-6.

79. Ganta R, Fee JP. Pain on injection of propofol: comparison of lignocaine with metoclopramide. Br J Anaesth. 1992 Sep;69(3):316-7.

80. Movafegh A, Mir Eskandari M , Eghtesadi Araghi P AComparison Of Metoclopramide And Lidocaine For Preventing Pain On Injection Of Propofol Tehran Univ Med J 2003, 61(4): 274-280.

81. Gehan G.et al, Optimal dose of Lignocaine for preventing pain on injection of Propofol; British Journal of Anaesthesia 1991; 66: 324-326

82. Brooker J. et al, Effect of Lignocaine on pain caused by Propofol injection; Anaesthesia; 1985.

83. Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence.Coderre TJ, Katz J, Vaccarino AL, Melzack R.Pain. 1993 Mar; 52(3):259-85

84. Ohnhaus, E. E. & Adler, R.(1975), Methodological problems in measurement of pain: A comparison between VAS & VRS, Pain, 1,379-84.

85. Hiller A et al, Injection pain, cardiovascular changes and recovery following induction of anaesthesia with Propofol in combination with alfentanil or lidocaine in children; ActaAnaesthesia Scandinavia; 1992 Aug; 36(6): 564-8.

86. A Wadaskar, N Swarnkar, A Yadav. Granisetron has superior control over postoperative nausea and vomiting than ondansetron in gynecological surgeries: a placebo controlled double-blind clinical study. The Internet Journal of Anesthesiology. 2008 Vol 20 Number 1.

87. Sabina Yeasmeen, Rubina Yasmin, AKM Akhtaruzzaman, UH Shahera Khatun. Intravenous Granisetron, Ondansetron and Metoclopramide in the Prevention and Treatment of Post Operative Nausea and Vomiting after Laparoscopic Cholecys-tectomy - A Comparative Study. Journal of BSA, Vol. 19, No. 1 & 2, 2006 p20-27.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles