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Injection pain with propofol: the effectiveness of thiopentone on induction
K I Cheng1, C S Tang, S L Chiu
1Department of Anesthesiology, Kaohsiung Medical College, Taiwan, Republic of China.
Insights
Thiopentone combined with propofol significantly reduced injection pain in children undergoing venous cannulation. This combination is recommended for anesthesia induction to improve patient comfort during painful procedures.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pain Management
Background:
- Venous cannulation in children can cause significant injection pain.
- Propofol is a common induction agent, but its injection can be painful.
- Lignocaine is often used to mitigate propofol injection pain.
Purpose of the Study:
- To evaluate the efficacy of different lignocaine doses mixed with propofol in reducing injection pain in pediatric patients.
- To compare the pain reduction efficacy of propofol-lignocaine mixtures with a thiopentone-propofol-lignocaine combination.
Main Methods:
- 127 children (3-6 years) were divided into four groups.
- Groups received varying doses of propofol with lignocaine or thiopentone followed by propofol with lignocaine.
- Pain was assessed using facial expression and limb withdrawal responses.
Main Results:
- Pain on injection was significantly more frequent in the lowest lignocaine dose group (L1) compared to the thiopentone group (T).
- Increasing lignocaine dose showed a trend towards reducing moderate/severe pain, but differences were not significant.
- Thiopentone administration prior to propofol-lignocaine significantly reduced injection pain incidence.
Conclusions:
- Pre-administration of thiopentone effectively reduces propofol injection pain in pediatric patients.
- The combination of thiopentone and propofol-lignocaine is recommended for anesthesia induction in children to minimize pain.
- Further research may explore optimal dosing for lignocaine in propofol mixtures.
Abstract:
One hundred and twenty-seven children aged 3-6 years were allocated to four groups. All of them received venous cannulation on the dorsum of the hand. On induction, the group L1, L2 and L3 patients received propofol 3 mg/kg mixed with lignocaine 0.15 mg/kg, 0.3 mg/kg, 0.6 mg/kg, respectively. The group T patients received thiopentone 3 mg/kg, then propofol 1.5 mg/kg mixed with lignocaine 0.075 mg/kg. Pain on injection was categorized into two-assessment items (facial expression and limbs withdrawal). The facial expression category were subdivided into none, mild (knit of brows), moderate (grimace), and severe (crying). The withdrawal of limbs was categorized into none, mild (withdrawal of hand), moderate (withdrawal of fore-arm and arm), severe (withdrawal of arm and twisting of body). Patients were monitored using an electrocardiogram, pulse oximeter, autonomic noninvasive blood pressure measuring device and capnography. The patient characteristics did not differ significantly among the four groups. Pain on injection was significantly more frequent in the group L1 patients (81%) compared with the group T (27%) patients. Increasing lignocaine dose reduced the incidence of pain graded as "moderate" or "severe" though there was no significant difference. The incidences of excitatory effect on propofol injection were reduced with increasing lignocaine dose and prior administration of thiopentone but there were no obviously differences among groups. We concluded that thiopentone reduced injection pain on propofol and should be recommended.