Characteristics that increase the risk for pain on propofol injection

Area of Science:

• Anesthesiology
• Pain Management
• Gastroenterology

Background:

• Propofol is widely used for anesthesia during endoscopic procedures.
• Pain on propofol injection (POPI) is a common and bothersome side effect.
• Identifying predictors of POPI is crucial for improving patient comfort.

Purpose of the Study:

• To identify patient characteristics and factors, including intravenous (IV) site and gauge, that predict the occurrence of POPI.
• To analyze the relationship between IV site (antecubital, forearm, hand) and POPI severity.
• To investigate the association of patient demographics and medical history with POPI.

Main Methods:

• Prospective chart review of 291 patients undergoing endoscopic procedures.
• Data collection included patient demographics, IV site, and IV gauge.
• POPI was assessed using a 0-3 pain score.

Main Results:

• The incidence of POPI was significantly higher with forearm and hand IV sites compared to antecubital (AC) sites.
• Patients with AC IVs experienced minimal to no pain (score >1 was rare).
• Factors associated with increased POPI included anxiety/depression, chronic narcotic use, fibromyalgia, and chronic pain syndromes.

Conclusions:

• Antecubital IV sites are associated with significantly lower rates of POPI compared to forearm and hand sites.
• Patient history of anxiety, depression, chronic narcotic use, fibromyalgia, and chronic pain are significant predictors of POPI.
• Premedication with analgesics or utilizing AC IV sites may mitigate POPI in at-risk patients.