A Randomized Control Trial of Hyoscine N-Butylbromide versus Lidocaine Pretreatment for Alleviating Pain on Propofol Injection

Main Article Content

Peerapong Sangsungnern
Isarapong Kochhirun
Viriya Thincheelong
Nootchanart Phoesri
Saranyoo Nonphiaraj
Siwalai Sucher
Siwalai Sucher


Propofol is commonly used in anesthesia practice according to its rapid and smooth induction, short duration, and low incidence of postoperative nausea and vomiting. However, discomfort from pain on propofol injection still be a problem.1-4 The incidence of this pain in adults ranged from 28 to 90% and its pain severity was moderate (average numeric rating scale (NRS) was 5.6±2.3).5-7 The mechanism of propofol injection pain was hypothesized that propofol likely irritates the innermost layer of vessels that causes directly stimulating free nerve ending and indirectly releasing of mediators and results in pain on injection.6-8 Several methods were used for alleviating propofol injection pain such as pretreatment of intravenous lidocaine with or without tourniquet, lidocaine mixed with propofol, and pretreatment with opioids, non-steroidal anti-inflammatory drugs, ketamine, or metoclopramide.6-9 Pre-treatment of lidocaine is a common technique to prevent propofol pain because of its local anesthetic effect on the vein and ease to application.7-9 Pretreatment of 30 to 60 mg of intravenous lidocaine with tourniquet was presumed to reduce this pain.9-11 However, appropriate dosages and methods of lidocaine administration were inconclusive and the efficacy of lidocaine administration on propofol injection pain was still varied. From earlier study, 20 mg of Hyoscine N-butylbromide (HBB) significantly alleviated propofol pain on injection when compared to placebo.12 HBB, a quaternary ammonium derivative which an anticholinergic drug, bound to peripheral anti-muscarinic receptors which are located notably in smooth muscle cells of gastrointestinal tract and blood vessels.13,14 It is used for relief abdominal, ureteric colic, labor pain, and prevent spasms of the gastrointestinal tract prior to invasive radiologic and diagnostic procedures, such as endoscopic retrograde cholangiopancreatography (ERCP) and colonoscopy.13-16 Common adverse effects of HBB were tachycardia, dry mouth, and blurred vision.14 This study was intended to compare the efficacy between pretreatment of HBB and lidocaine in adjunction with tourniquet to alleviate propofol pain on injection.

Article Details

Original articles


Sahinovic MM, Struys M, Absalom AR. Clinical pharmacokinetics and pharmacodynamics of propofol. Clin Pharmacokinet. 2018;57:1539-58.

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

Salman AE, Salman MA, Saricaoglu F, Akinci SB, Aypar U. Pain on injection of propofol: a comparison of methylene blue and lidocaine. J Clin Anesth. 2011;23:270-4.

Kang HJ, Kwon MY, Choi BM, Koo MS, Jang YJ, Lee MA. Clinical factors affecting the pain on injection of propofol. Korean J Anesthesiol. 2010;58:239-43.

Gharavi M, Sabzevari A, Ghorbanian E, Sajadi R, Akhondi M. Effect of lidocaine volume and concentration on preventing incidence and severity of propofol injection pain. Iran Red Crescent Med J. 2014;16:e16099.

Desousa KA. Pain on propofol injection: causes and remedies. Indian J Pharmacol. 2016;48:617-23.

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

Doenicke AW, Roizen MF, Rau J, Kellermann W, Babl J. Reducing pain during propofol injection: the role of the solvent. Anesth Analg. 1996;82:472-4.

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

Euasobhon P, Dej-Arkom S, Siriussawakul A, et al. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016;2:CD007874.

Kim DH, Chae YJ, Chang HS, Kim JA, Joe HB. Intravenous lidocaine pretreatment with venous occlusion for reducing microemulsion propofol induced pain: comparison of three doses of lidocaine. J Int Med Res. 2014;42:368-75.

Sargin M, Uluer MS, Aydogan E. Hyoscine N-Butylbromide for preventing propofol injection pain: a randomized, placebo-controlled and

double-blind study. Med Princ Pract. 2018;27:39-43.

Samuels LA. Pharmacotherapy update: hyoscine butylbromide in the treatment of abdominal spasms. Clin Med Ther. 2009;1:647-55.

Tytgat GN. Hyoscine butylbromide-a review on its parenteral use in acute abdominal spasm and as an aid in abdominal diagnostic and therapeutic procedures. Curr Med Res Opin. 2008;24:3159-73.

Papadopoulos G, Bourdoumis A, Kachrilas S, Bach C, Buchholz N, Masood J. Hyoscine N-Butylbromide (Buscopan®) in the treatment of acute ureteral colic: what is the evidence? Urol Int. 2014;92:253-7.

Samuels LA, Christie L, Roberts-Gittens B, Fletcher H, Frederick J. The effect of hyoscine butylbromide on the first stage of labour in term pregnancies. BJOG. 2007;114:1542-6.

Jeong M, Yoon H. Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: randomized, double-blind controlled trial. Int J Nurs Stud. 2016;61:209-18.

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