Reduction of pain on injection from propofol by pretreatment with cold pack: a randomized controlled trial

Prangmalee Leurcharusmee

Authors

Prangmalee Leurcharusmee

Keywords:

propofol, pain on injection, lidocaine, cold pack

Abstract

Background: Propofol is known to be associated
with pain on injection. There have been reported of
moderate to severe pain following the injection of
propofol approximately 85% of affected patients.
The mechanism causing the pain, however, remains
unclear and there are no absolute solutions. This study
was performed to verify that a pretreatment with cold
pack, an alternative to propofol premixed with lidocaine,
can decrease the incidence of moderate to severe pain
during the injection. Methods: One-hundred and
twenty patients were recruited to a randomized
controlled trial and allocated equally into two groups.
The patients who had an inserted intravenous catheter
at the position except the dorsum of a hand and with
the size other than 20G and 22G were excluded. In the
lidocaine + propofol (LP) group, a cold pack at a room
temperature was placed on the skin at the intravenous
catheter site. While, in the other group, the cold pack
(CP) group, the cold pack at -10 degree Celsius was
left for one to five minute (s) over the intravenous
catheter. Twenty mL of 1% propofol premixed with
20 mg of 2% lidocaine and 20 mL of plain 1% propofol,
for the LP and CP groups respectively, were infused
with a dose of 2 mg/kg in one minute. Pain scores
on the injection, patient satisfaction, and recalling of
the pain at the intravenous site during an induction of
anesthesia were recorded as primary and secondary
outcomes. Results: Temperature at the skin after the
cold pack placement in CP group was around 18.6 ± 3.3
degree Celsius. Forty percent of the patients in this
group had no pain on the injection. However, fifty-
five percent of them reported moderate to severe pain,
which was significantly higher than those in the LP
group (p-value < 0.001). The patients in both groups
recalled the occurrence of the pain on the injection
similarly. Conclusions: Pretreatment with the cold
pack provided a modest reduction of the pain during
the propofol injection without hazard from the cold
temperature. Although this alternative technique was
not as effective as the injection of the propofol
premixed with lidocaine, the longer duration of the
cold pack placement was noted to improve the
outcome. The optimal usage of the cold pack to
minimize the pain on the injection should be further
studied.

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