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Propofol infusion rate does not affect local pain on injection
A Grauers1, E Liljeroth, J Akeson
1Institution, Department of Anesthesia and Intensive Care, Lund University, Malmö University Hospital, Malmö, Sweden.
Insights
The injection speed of propofol (Diprivan) does not affect pain at the injection site. Adjusting intravenous infusion rates is not a useful method for reducing propofol-induced pain.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Local pain during intravenous propofol injection is a common issue, especially in pediatric patients.
- This study investigated the impact of infusion rate on injection site pain.
Purpose of the Study:
- To determine if altering the intravenous bolus infusion rate of propofol affects the incidence, intensity, or duration of local pain.
- To assess the clinical utility of adjusting injection speed for pain management.
Main Methods:
- A randomized, investigator-blinded, crossover study involving 30 patients undergoing elective surgery.
- Propofol (10 mg/ml) was administered in 2.0 ml boluses at two different rates (0.2 ml/s and 1.0 ml/s).
- Pain intensity and duration were assessed using visual analog and numerical rating scales.
Main Results:
- No statistically significant difference in pain incidence (86% for both rates) was observed.
- Pain intensity (median VAS: 3.1 vs. 3.3) and duration (66s vs. 73s) did not differ significantly between the faster and slower infusion rates.
- The study found no correlation between infusion rate and patient-reported pain outcomes.
Conclusions:
- The intravenous bolus infusion rate of propofol does not appear to influence drug-induced local pain at the injection site within the studied range.
- Modifying propofol injection speed is unlikely to be an effective clinical strategy for mitigating injection site pain.
Background:
Local pain at the site of an i.v. injection of propofol is a well-known problem, particularly in infants. This randomised investigator-blinded crossover study was designed to assess the effect of the i.v. bolus infusion rate on propofol-induced pain at the site of injection.
Methods:
Thirty unpremedicated patients scheduled for ear-nose-throat or plastic surgery at Malmö University Hospital, Sweden, were given two consecutive 2.0 ml injections of propofol 10 mg/ml (Diprivan, AstraZeneca, Sweden/UK), at different infusion rates (0.2 or 1.0 ml/s), immediately before induction of general anesthesia. Half of the patients (n=15) received the first bolus of propofol over 2 s and the second bolus over 10 s, and the other half (n=15) had their injections in reversed order. After each injection, the patient was asked by an investigator to indicate pain intensity on a visual analog scale (VAS) and to report the times of the appearance, maximum point and disappearance of pain. The injections were given approximately 2 min apart. The investigators scoring pain intensity, as indicated by the patients on a 10-point numerical rate scale, were blinded to the order in which the injections were given, as were the patients themselves.
Results:
There were no statistically significant differences in the incidence (both 86%) of intensity (median; 25th; 75th percentiles, in VAS units: 3.1; 1.0; 5.3 and 3.3; 1.4; 5.0, respectively) or duration (66+/-31 and 73+/-26 s, respectively) of pain between the faster (1.0 ml/s) and slower (0.2 ml/s) bolus infusion rates of propofol studied.
Conclusions:
We conclude that the i.v. bolus infusion rate of propofol does not influence drug-induced local pain on injection, at least not within the infusion rate interval studied. Therefore, adjusting i.v. injection speed does not seem to be a clinically useful tool for reducing the intensity or duration of propofol-induced pain at the site of administration.