Comparison of Dexamethasone and Ondansetron with Lidocaine on Propofol Injection Pain

Main Article Content

Poonyanuch Charoenkoop


Background: Propofol has widely used as an anesthetic induction and maintenance agent. Sixty percent of patients experienced pain on propofol injection. There were evidences that both dexamethasone and ondansetron can reduce propofol injection pain. But the effectiveness of each drug is inconclusive when compare to lidocaine. We hypothesized that combination of dexamethasone and ondansetron is non-inferiority to lidocaine for reducing propofol injection pain. Methods: 178 adult patients, ASA physical status I-III, undergoing elective surgery were randomly assigned to two groups. Group L received 2 mL of 2% preservative free lidocaine, group DO received dexamethasone 10 mg and follow by ondansetron 4 mg intravenously, 1 minute prior to 0.3 of propofol injection. Pain score, facial grimacing, vocalization and hand withdrawal were recorded 10 seconds after propofol injection. Results: Overall incidences of propofol injection pain after pretreatment (34.83% versus 42.69% in group L and group DO, respectively, p = 0.26) and moderate to severe pain (11.24% versus 12.36% in group L and group DO, respectively, p = 0.81) were not different between the two groups. In order to prove the non-inferiority of dexamethasone and ondansetron combination against lidocaine, the upper limit of the 90% confidence interval must be lower than the predefined margin of non-inferiority (3%). The upper limit of the incidence of moderate to severe pain was 2.99% which was lower than the predefined 3%. Conclusion: Combination of dexamethasone 10 mg and ondansetron 4 mg was comparable to lidocaine 40 mg for pretreatment on propofol injection pain.

Article Details

Original articles


1. Sebel PS, Lowdon JD. Propofol: a new intravenous
anesthetic. Anesthesiology 1989;71:260-77.
2. Jalota L, Kalira V, George E, et al. Prevention of pain on
injection of propofol: systematic review and meta-analysis.
Br Med J 2011;342:d1110.
3. Kindgen-Milles D, Arndt JO. Nitric oxide as a chemical link
in the generation of pain from veins in humans. Pain
4. Moreno L, Martinez-Cuesta MA, Muedra V, et al. Role of the
endothelium in the relaxation induced by propofol and
thiopental in isolated arteries from man. J Pharm Pharmacol
5. Murphy GS, Szokol JW, Avram MJ, et al. The effect of single
low-dose dexamethasone on blood glucose concentrations
in the perioperative period: a randomized, placebocontrolled investigation in gynecologic surgical patients.
Anesth Analg 2014;118:1204-12.
6. Park WK, Lynch C 3rd, Johns RA. Effects of propofol and
thiopental in isolated rat aorta and pulmonary artery.
Anesthesiology 1992;77:956-63.
7. Picard P, Tramer MR. Prevention of pain on injection with
propofol: a quantitative systematic review. Anesth Analg
8. Shaikh SI, Nagarekha D, Hegade G. Postoperative nausea
and vomiting: a simple yet complex problem. Anesth Essays
Res 2016;10:388-96.
9. De Oliveira GS Jr, Almeida MD, Benzon HT. Perioperative
single dose systemic dexamethasone for postoperative
pain: a meta-analysis of randomized controlled trials.
Anesthesiology 2011;115:575-88.
10. Ahmad S, De Oliveira GS Jr, Fitzgerald PC. The effect of
intravenous dexamethasone and lidocaine on propofolinduced vascular pain: a randomized double-blinded
placebo-controlled trial. Pain Res Treat 2013;734531.
11. Sunny A, Veerabhadraiah T, Trivikram S. Comparison of
pretreatment with lignocaine and ondansetron for pain on
injection of propofol during induction of anaesthesia. The
Internet Journal of Anesthesiology 2013;32:1-4.
12. Gan TJ, Meyer T, Apfel CC,et al. Consensus guidelines for
managing postoperative nausea and vomiting. Anesth Analg
13. Kwak KH, Ha J, Kim Y. Efficacy of combination intravenous
lidocaine and dexamethasone on propofol injection pain:
a randomized, double-blind, prospective study in adult
Korean surgical patients. Clin Ther 2008;30:1113-9.
14. 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.
15. Morishima T, Sobue K, Arima H, et al. Profound pain due to
propofol injection triggered myocardial ischemia in a patient
with a suspected pheochromocytoma. Anesth Analg
16. Henry J, Pfeifer DJG, Jan Koch-Weser. Clinical use and
toxicity of intravenous lidocaine: A report from the Boston
Collaborative Drug Surveillance Program. Am Heart J
17. Chu CC, Hsing CH, Shieh JP. The cellular mechanisms of
the antiemetic action of dexamethasone and related
glucocorticoids against vomiting. Eur J Pharmacol 2014;
18. Swift JQ, Roszkowski MT, Alton T. Effect of intra-articular
versus systemic anti-inflammatory drugs in a rabbit model of
temporomandibular joint inflammation. J Oral Maxillofac Surg
19. Singh M, Mohta M, Sethi AK. Efficacy of dexamethasone
pretreatment for alleviation of propofol injection pain. Eur J
Anaesthesiol 2005;22:888-90.
20. Perron G, Dolbec P, Germain J. Perineal pruritus after i.v.
dexamethasone administration. Can J Anaesth 2003;50:
21. Milne RJ, Heel RC. Ondansetron. Drugs 1991;41:574-95.
22. Ye JH, Mui WC, Ren J. Ondansetron exhibits the properties
of a local anesthetic. Anesth Analg 1997;85:1116-21.
23. Piper SN, Rohm KD, Papsdorf M. Dolasetron reduces pain
on injection of propofol. Anasthesiol Intensivmed Notfallmed
Schmerzther 2002;37:528-31.
24. Reddy MS, 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;56:902-5.
25. Singh D, Jagannath S, Priye S. Prevention of propofol
injection pain: comparison between lidocaine and
ramosetron. J Anaesthesiol Clin Pharmacol 2014;30:213-6.
26. Zahedi H, Maleki A, Rostami G. Ondansetron pretreatment
reduces pain on injection of propofol. Acta Med Iran