DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20220058

A comparative study of intravenous lignocaine, dexamethasone and combination of lignocaine-dexamethasone in attenuating propofol induced pain

Biby Mary Kuriakose, Kavitha Krishnakumar

Abstract


Background: General anesthesia is preferred during surgeries to reduce the pain stimuli in patients and to increase the precision of surgical procedure. Propofol is amongst the most widely used general anesthetic agent with limitation of induced pain during administration. Current study was conducted to compare the effect of intravenous pre-administration of various drugs in attenuating propofol induced pain.  

Methods: A comparative observational study was conducted on patients of either sex and aged between 18-60 years. Patients were divided in three groups, who received intravenous lignocaine, dexamethasone and combination of lignocaine-dexamethasone respectively to attenuate propofol induced pain. Different variables like HR, SBP, DBP, MAP, RR SpO2 and any adverse events were monitored in all the patients.  

Results: The 46.66% and 53.33% patients who received lignocaine and dexamethasone alone perceived propofol induced mild to moderate pain; while only 23.33% patients who received lignocaine and dexamethasone in combination perceived mild propofol induced pain. The propofol induced pain event was persistent in only 2 out of 30 patients after a time lapse of 30 seconds for the group receiving lignocaine and dexamethasone in combination. Whereas, the pain event was present even after time lapse of 30 seconds in 08 and 07 out of 30 patients of groups receiving lignocaine and dexamethasone alone.

Conclusions: Pre-administration of lignocaine and dexamethasone in combination attenuated the propofol induced pain more significantly in comparison to single administration of mentioned drugs. No significant adverse events except perianal irritation were observed in some patients who received combination of lignocaine and dexamethasone intravenously.


Keywords


Propofol induced pain, Lignocaine, Dexamethasone, General anesthesia, Surgery

Full Text:

PDF

References


Forman SA, Chin VA. General anesthetics and molecular mechanisms of unconsciousness. Int Anesthesiol Clin. 2008;46(3):43-53.

Dodds C. General anaesthesia: practical recommendations and recent advances. Drugs. 1999;58(3):453-67.

Grasshoff C, Rudolph U, Antkowiak B. Molecular and systemic mechanisms of general anaesthesia: the 'multi-site and multiple mechanisms' concept. Curr Opin Anaesthesiol. 2005;18:386-91.

Woodbridge PD. Changing concepts concerning depth of anesthesia. Anesthesiology. 1957;18:536-50.

Forman SA. Awareness During general anesthesia: concepts and controversies. seminars in anesthesia. Perioperat Med Pain. 2006;25:211-8.

Stiegler MP, Ruskin KJ. Decision-making and safety in anesthesiology. Curr Opin Anaesthesiol. 2012;25(6):724-9.

Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018;57(12):1539-58.

Baker MT, Naguib M. Propofol: the challenges of formulation. Anesthesiology. 2005;103:860-76.

Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation. Drugs. 1995;50:513-59.

Fulton B, Sorkin EM. Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs. 1995;50:636-57.

Trapani G, Altomare C, Liso G, Sanna E, Biggio G. Propofol in anesthesia. Mechanism of action, structure-activity relationships, and drug delivery. Curr Med Chem. 2000;7:249-71.

Kotani Y, Shimazawa M, Yoshimura S, Iwama T, Hara H. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci Ther. 2008;14(2):95-106.

Anwar MM, Abdel‐Rahman MS (1998) Effect of propofol on perception of pain in mice: mechanisms of action. Comp Biochem Physiol. 120:249-53.

Marik PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10(29):3639-49.

Tham CS, Khoo ST. Modulating effects of lignocaine on propofol. Anaesth Intensive Care. 1995;23(2):154-7.

Mecklem DW. Propofol injection pain: comparing the addition of lignocaine or metoclopramide. Anaesth Intensive Care. 1994;22(5):568-70.

Sakellaris G, Georgogianaki P, Astyrakaki E, Michalakis M, Dede O, Alegakis A et al. Prevention of post-operative nausea and vomiting in children--a prospective randomized double-blind study. Acta Paediatr. 2008;97:801-4.

Tilahun BA, Admasu W, Mulugeta S, Bacha AR, Getnet Demsie D. Effectiveness of propofol versus dexamethasone for prevention of postoperative nausea and vomiting in ear, nose, and throat surgery in tikur anbessa specialized hospital and Yekatit 12th Hospital, Addis Ababa, Ethiopia. Anesthesiol Res Pract. 2020;2020:4258137.

Fujii Y, Nakayama M, Nakano M. Propofol alone and combined with dexamethasone for the prevention of postoperative nausea and vomiting in adult Japanese patients having third molars extracted. Br J Oral Maxillofac Surg. 2008;46(3):207-10.

Euasobhon P, Dej-Arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, Lumbiganon P. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016;2(2):CD007874.

Kaya S, Turhanoglu S, Karaman H, Ozgün S, Basak N. 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 Clin Exp. 2008;69(1):29-35.

Sumalatha GB, Dodawad RR, Pandarpurkar S, Jajee PR. A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron. Indian J Anaesth. 2016;60(1):25-9.

Mecklem DW. Propofol injection pain: comparing the addition of lignocaine or metoclopramide. Anaesth Intensive Care. 1994;22(5):568-70.

Ahmad S, De Oliveira GS Jr, Fitzgerald PC, McCarthy RJ. The effect of intravenous dexamethasone and lidocaine on propofol-induced vascular pain: a randomized double-blinded placebo-controlled trial. Pain Res Treat. 2013;2013:734531.

Kim J, Jang GD, Kim DS, Min KT. Small dose of propofol combined with dexamethasone for postoperative vomiting in pediatric Moyamoya disease patients: a prospective, observer-blinded, randomized controlled study. Korean J Anesthesiol. 2013;64(2):127-32.

Xing J, Liang L, Zhou S, Luo C, Cai J, Hei Z. Intravenous Lidocaine Alleviates the Pain of Propofol Injection by Local Anesthetic and Central Analgesic Effects. Pain Med. 2018;19(3):598-607.

Matchett G, Wood P. General anesthesia suppresses normal heart rate variability in humans. Chaos. 2014;24(2):023129.

Zheng G, Dong W, Lewis CM. General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients with a History of Head and Neck Radiation Therapy. Anesth Analg. 2017;125(6):2056-62.

Momota Y, Kaneda K, Arishiro K, Kishimoto N, Kanou S, Kotani J. Changes in blood pressure during induction of anesthesia and oral and maxillofacial surgery by type and timing of discontinuation of antihypertensive drugs. Anesth Prog. 2010;57(1):13-7.

Wiórek A, Krzych ŁJ. Intraoperative Blood Pressure Variability Predicts Postoperative Mortality in Non-Cardiac Surgery-A Prospective Observational Cohort Study. Int J Environ Res Public Health. 2019;16(22):4380.

Mascha EJ, Yang D, Weiss S, Sessler DI. Intraoperative Mean Arterial Pressure Variability and 30-day Mortality in Patients Having Noncardiac Surgery. Anesthesiology. 2015;123(1):79-91.

Ball L, Costantino F, Fiorito M, Amodio S, Pelosi P. Respiratory mechanics during general anaesthesia. Ann Transl Med. 2018;6(19):379.

Saraswat V. Effects of anaesthesia techniques and drugs on pulmonary function. Indian J Anaesth. 2015;59(9):557-64.

Hempenstall PD, De Plater RM. Oxygen saturation during general anaesthesia and recovery for outpatient oral surgical procedures. Anaesth Intensive Care. 1990;18(4):517-21.

Baharav E, Harpaz D, Mittelman M, Lewinski UH. Dexamethasone-induced perineal irritation. N Engl J Med. 1986 Feb 20;314(8):515-6.

Klygis LM. Dexamethasone-induced perineal irritation in head injury. Am J Emerg Med. 1992;10(3):268.