A prospective, randomized, double blind study to evaluate and compare the efficacy of lidocaine, ramosetron and tramadol pre-medication, in attenuating the pain caused due to propofol injection

Authors

  • Ifra Zahoor Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India
  • Aabid Hussain Mir Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India
  • Mohmad Syed Qazi Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India
  • Zahoor Ahmad Jan Department of Anaesthesiology, Al-Jabr Eye and ENT hospital, Al-Hofuf, Dammam, Saudi Arabia
  • Abida Yousuf Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India
  • Ajaiz Rasool Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20172463

Keywords:

Lidocaine, Ramosetron, Pain, Propofol, Tramadol

Abstract

Background: Propofol is a popular induction agent, especially for short cases, day care surgeries and when a laryngeal mask is to be used. It produces a good quality of anaesthesia and rapid recovery. Pain on injection of propofol has been reported and is an important limitation of its use. A multitude of interventions: pharmacological as well as non-pharmacological, have been tried for the attenuation of pain caused due to propofol injection. In our study, we evaluated and compared the efficacy of lidocaine, ramosetron and tramadol in attenuating pain on propofol injection.

Methods: A total of 180 patients belonging to American Society of Anesthesiologists (ASA) grade I and II,  of either sex, aged between 21 to 50 years undergoing elective surgery under general anaesthesia, were taken up for the study and were divided into group A, B and C. Group A received 2ml of 2% (40mg) lidocaine, Group B received 2ml of ramosetron (0.3mg) and Group C received 1mg/kg of tramadol in 0.9% normal saline to make a total solution of 2ml. Venous occlusion was done by compressing forearm with tourniquet to increase the local concentration of drug after establishing an intravenous access. The study drug was injected over 10 seconds and then occlusion was removed after 60 seconds, followed by giving 25% of the total calculated dose (2.5mg/kg) of propofol (1% w/v in lipid base) injected over 20 seconds. This was followed by asking the patient about the severity of pain felt. The intensity of pain was graded using verbal rating scale (McCrirrick and Hunter) and was assessed at 0, 5, 10, 15 and 20 seconds, as after 20 seconds, the patient would be under the influence of propofol.

Results: Lidocaine showed the best efficacy in attenuating propofol injection pain amongst the 3 groups recorded at 5 (95%), 10 (91.7%) and 15 seconds (98.3%). In addition to reducing the incidence of pain, it also reduced its severity, with majority of patients experiencing only mild pain. Ramosetron ranked 2nd in the overall reduction of propofol pain, with lowest incidence of propofol pain amongst 3 groups, recorded at 0 (98.3%) and 20 seconds (95%) of propofol injection. However, ramosetron failed in reducing severity of pain, with a significant number of patients experiencing moderate and severe pain. Tramadol ranked 3rd in the overall attenuation of propofol pain and showed lowest incidence of pain at 0 seconds (93%) of propofol injection.

Conclusions: All the three study drugs viz lidocaine, ramosetron and tramadol cause a significant decrease in propofol injection pain with lidocaine as the most efficacious drug amongst the 3 drugs followed by ramosetron and tramadol. Lidocaine has an added advantage of decreasing incidence and severity of pain associated with propofol and ramosetron prevents postoperative nausea and vomiting.

Author Biographies

Ifra Zahoor, Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

Junior Resident, Department of Anaesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India-190011.

Aabid Hussain Mir, Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

Senior Resident, Department of Anaesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India-190011.

Mohmad Syed Qazi, Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

Professor, Department of Anaesthesiology and Critical Care,
Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India-190011.

Zahoor Ahmad Jan, Department of Anaesthesiology, Al-Jabr Eye and ENT hospital, Al-Hofuf, Dammam, Saudi Arabia

Consultant, Department of Anaesthesiology, Al-Jabr Eye and ENT hospital, Al-Hofuf, Dammam, Saudi Arabia.

Abida Yousuf, Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

Junior Resident, Department of Anaesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India-190011.

Ajaiz Rasool, Department of Anaesthesiology and Critical Care, SKIMS, Soura, Srinagar-190011, Jammu and Kashmir, India

Senior Resident, Department of Anaesthesiology and Critical Care, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, India-190011.

References

Johnson, Harper NJN, Chadwick S, Vohra A. Pain on injection of propofol. Anaesthesia. 1998;53:468-76.

Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:d1110.

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

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

Yull DN, Barkshire KF, Dexter T. Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol. Anaesthesia. 2000;55:284-7.

Doenicke AW, Rozen MF, Ran J, Kelleriman W. Reducing pain during propofol injection- The role of the solvent. Anesth Analg. 1996;82:472-4.

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

Yoshikawa T, Wajima Z, Ogura A, Inoue T, Ogawa R. Orally administered clonidine significantly reduces pain during injection of propofol. Br J Anaesth. 2001;86(6):874-6.

Erdil FA, Gulhas N, But AK. Does single dose premedication of dexmedetomidine reduce pain during injection of propofol? Pain Clinic. 2007;19:21-5.

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

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

Ahmed A, Sengupta S, Das T, Rudra A. Pretreatment with intravenous granisetron to alleviate pain on propofol injection: A double blind, randomized, controlled trial. Indian J Anesth. 2012;56(2):135-8.

Alipour M, Tabari M, Alipour M. Paracetamol, ondansetron, granisetron, magnesium sulfate and lidocaine and reduced propofol injection pain. Iran Red Crescent Med J. 2014;16(3):e16086.

Kau YC, Wu RS, Cheng KS. Propofol-sodium thiopental admixture reduces pain on injection. Acta Anaesthesiol Sin. 2000;38:9-13.

Azma T, Kawai K, Tamura H. Comparative benefit of preemptively applied thiopental for propofol injection pain: the advantage over lidocaine. Hiroshima J Med Sci. 2004;53:13-6.

Galvez-Escalera I, Thorpe CM. The effect of co-induction with midazolam on propofol injection pain. Eur J Anaesthesiol. 2004;21:579-81.

Shah MH, Gandhi S, Chadha IA. Comparison of midazolam co-induction with propofol predosing for induction of anaesthesia. J Anaesthesiol Clin Pharmacol. 2008;24:197-200.

Pang WW, Mok MS, Wang CS. Can neostigmine reduce propofol injection pain? Acta Anaesthesiol Sin. 2002;40:65-9.

Iwama H, Nakane M, Ohmori S. Nafamostat mesilate, a kallikrein inhibitor, prevents pain on injection with propofol. Br J Anaesth. 1998;81;963-4.

Zashedi H, Nikooseresht M Seifrabie M. Prevention of propofol injection pain with small dose ketamine. Middle East J Anesthesiol. 2009;20;401.

Rahimzadeh P, Faiz SH, Nikoobakht N. Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial. Adv Biomed Res. 2015;4:56.

Singh DK, Jindal P, Singh G. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulphate and nitroglycerine. Saudi J Anaesth. 2011;5:50-4.

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

Wong WH, Cheong KF. Role of tramadol in reducing pain on propofol injection. Singapore Med J. 2001;42:193-5.

Basaranoglu G, Erden V, Delatioglu H, Saitoglu L. Reduction of pain on injection of propofol using meperdine and remifentanil. Eur J Anaesthesiol. 2005;22:890-2.

Lee JR, Jung CW, Lee YH. Reduction of pain during induction with target controlled propofol and remifentanil. Br J Anaesth. 2007;99:876-80.

Singh M, Mohta M, Sethi AK, Tyagi A. Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain. Eur J Anesthesiol. 2005;22:888-90.

Yadav M, Durga P, Gopinath R. Role of hydrocortisone in prevention of pain on propofol injection. J Anaesth Clin Pharmacol. 2011;27:460-4.

Eriksson M. Prilocaine reduces injection pain caused by propofol. Acta Anaesthesiol Scand. 1995;39:210-3.

Kaya S, Turhanoglu S, Karaman H. 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. Curr Ther Res. 2008;69:29-35.

Kobayashi Y, Tsuchida A, Kamada Y, Seki S, Ichimiya T, Namiki A. Effects of the bolus injection rate on anesthesia induction with propofol. Masui. Japanese J Anesthesiol. 1999;48(8):852-5.

Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988;43:492-4.

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

Tariq MA, Kamran M. Incidence of pain on propofol injection and efficacy of addition of lignocaine or selecting big vein or both combined in reducing it: a randomized control trial. J Postgrad Med Inst. 2006;20:8-11.

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

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

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

Ozturk E, Izdes S, Babacan A. Temperature of propofol does not reduce the incidence of injection pain. Anaesthesiology. 1998;89:1041.

Minogue SC, Sun DA. Bacteriostatic saline containing benzyl alcohol decreases the pain associated with the injection of propofol. Anesth Analg. 2005;100:683-6.

Ye JH, Mui WC, Ren J. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg 1997;85:1116-21.

Suzuki R, Morcuende S, Webber M. Superficial NK-1 expressing neurons control spinal excitability through activation of descending pathways. Nat Neurosci. 2001;5:1319-26.

Zeitz KP, Guy N, Malmberg AB, Dirajlal S, Martin WJ, Sun L, et al. The 5-HT3 subtype of serotonin receptor contributes to nociceptive processing via a novel subset of myelinated and unmyelinated nociceptors. J Neurosci. 2002;22(3):1010-9.

Tsai YC, Chang PJ, Jou IM. Direct tramadol application on sciatic nerve inhibits spinal somatosensory evoked potentials in rats. Anesth Analg. 2001;92(6):1547-51.

Cose JB. Oral tramadol for the treatment of pain of 7-30 days duration in children. Anaesth Analg. 2003;96:78-81.

Mert T, Gunes Y, Guven M, Gunay I, Ozcengiz D. Comparison of nerve conduction blocks by an opioid and a local anesthetic. Eur J Pharmacol. 2002;439(1):77-81.

Johnson RA, Harper NJ, Chadwick S. Pain on injection of propofol: methods of alleviation. Anaesthesia. 1990;45:439-42.

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

Kaya S, Turhanoglu S, Karaman H. 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. Curr Ther Res. 2008;69:29-35.

Sumalatha GB, Dodawad RR. A comparative study of attenuation of propofol induced pain by lignocaine, ondansetron and ramosetron. Indian J Anaesth. 2016;60:25-9.

Singh D, Jagannath S, Priye S. Prevention of propofol injection pain: Comparison between lidocaine and ramosetron. J Anaesthesiol Clin Pharmacol. 2014;30(2):213.

Lee HY, Kim SH, So KY. Prevention of microemulsion propofol injection pain: a comparison of a combination of lidocaine and ramosetron with lidocaine or ramosetron alone. Korean J Anesthesiol. 2011;61(1):30-4.

Pang WW, Huang PY, Chang DP, Huang MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine. Regional Anesth Pain Med. 1999;24(3):246-9.

Borazan H, Sahin O, Kececioglu A, Uluer MS, Et T, Otelcioglu S. Prevention of propofol injection pain in children: A comparison of pretreatment with tramadol and propofol-lidocaine mixture. Int J Med Sci. 2012;9(6):492-7.

Downloads

Published

2017-05-27

How to Cite

Zahoor, I., Mir, A. H., Qazi, M. S., Jan, Z. A., Yousuf, A., & Rasool, A. (2017). A prospective, randomized, double blind study to evaluate and compare the efficacy of lidocaine, ramosetron and tramadol pre-medication, in attenuating the pain caused due to propofol injection. International Journal of Research in Medical Sciences, 5(6), 2644–2651. https://doi.org/10.18203/2320-6012.ijrms20172463

Issue

Section

Original Research Articles