Dolor venoso inducido por propofol

Reducción de dolor de la inyección de propofol utilizando la teoría de las compuertas Reduction of propofol injection pain by utilizing the gate control theory. Kim SY, Jeong DW, Jung MW, Kim JM. Department of Anesthesiology and Pain Medicine, School of Medicine, Keimyung University, Daegu, Korea. Korean J Anesthesiol. 2011 Oct;61(4):288-91. Epub 2011 Oct 22. Abstract BACKGROUND: Propofol is the most commonly using intravenous hypnotic for the induction and maintenance of general anesthesia. However, pain on propofol injection is a well known adverse event. Currently, acute and chronic pain can be controlled by utilizing the "gate control" theory. METHODS: Patients were randomized to receive lidocaine (0.5 mg/kg; Group L), touch on IV injection site (Group T), combination lidocaine (0.5 mg/kg) and touch on IV injection site (Group B), or normal saline (Group S) with venous occlusion for 1 minute, followed by administration of propofol (0.5 mg/kg) into the largest dorsal vein of the hand. Immediately after administering propofol, an investigator blinded to the group assignments asked the patient about pain at the injection site and assessed pain intensity using a 4-point verbal rating scale (0 = none, 1 = mild, 2 = moderate, 3 = severe). RESULTS: A significant decrease in the incidence of pain on propofol injection was achieved in group L (37%) and group B (23%) compared to either group T (80%) and group S (83%) (P < 0.001). But, the incidence of moderate and severe pain was significantly lower in group L (7%), group T (20%) and group B (0%) when compared to group S (53%) (P < 0.05). CONCLUSIONS: Light touch and rubbing reduced pain, although while, they did not reduce the incidence of pain, they reduced the intensity of pain. This method might be considered as an alternative to other treatments but may be contraindicated for use with other drugs. http://ekja.org/Synapse/Data/PDFData/0011KJAE/kjae-61-288.pdf  Papel de la hidrocortisona en la prevención de dolor por inyección de propofol.  Role of hydrocortisone in prevention of pain on propofol injection. Yadav M, Durga P, Gopinath R. Department of Anesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, India. J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):470-4. Abstract BACKGROUND AND OBJECTIVES: Pain following intravenous injection of propofol continues to be an intriguing problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. Role of hydrocortisone in attenuating pain has not been evaluated. This study was conducted to compare the efficacy of lignocaine and hydrocortisone in attenuation of pain following intravenous injection of propofol. MATERIALS AND METHODS: A prospective randomized double-blind, placebo-controlled study was conducted on 72 adult patients belonging to American Society of Anesthesiologists (ASA) physical status I or II, scheduled to undergo elective surgery. They were randomly assigned to four groups of 18 each. Group NS, group LG, group HC10, and group HC25. The groups received 2 ml normal saline, 2 ml 2% lignocaine, 10 mg/2 ml hydrocortisone, and 25 mg/2 ml hydrocortisone, respectively, as pretreatment. Propofol was injected 30 sec later. A blinded researcher assessed the patient's pain level using a four point verbal rating scale. RESULTS: The four groups were comparable in respect to patient's characteristics. There was no significant difference of hemodynamics changes during propofol induction between all the groups. There was no statistically significant difference in the incidence of pain between patients who received hydrocortisone and the placebo group. The incidence of pain was significantly less in group LG than other three groups. CONCLUSION: Use of intravenous low dose hydrocortisone pretreatment of the vein does not attenuate pain following propofol injection. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214550/?tool=pubmed   Prevención del dolor de la inyección de propofol: revisión sistemática y meta análisis. Prevention of pain on injection of propofol: systematic review and meta-analysis. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel CC; Perioperative Clinical Research Core. Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, 94115 CA, USA. BMJ. 2011 Mar 15;342:d1110. doi: 10.1136/bmj.d1110. Abstract OBJECTIVE: To systematically determine the most efficacious approach for preventing pain on injection of propofol. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Embase, Cochrane Library,www.clinicaltrials.gov, and hand searching from the reference lists of identified papers. STUDY SELECTION: Randomised controlled trials comparing drug and non-drug interventions with placebo or another intervention to alleviate pain on injection of propofol in adults. RESULTS: Data were analysed from 177 randomised controlled trials totalling 25,260 adults. The overall risk of pain from propofol injection alone was about 60%. Using an antecubital vein instead of a hand vein was the most effective single intervention (relative risk 0.14, 95% confidence interval 0.07 to 0.30). Pretreatment using lidocaine (lignocaine) in conjunction with venous occlusion was similarly effective (0.29, 0.22 to 0.38). Other effective interventions were a lidocaine-propofol admixture (0.40, 0.33 to 0.48); pretreatment with lidocaine (0.47, 0.40 to 0.56), opioids (0.49, 0.41 to 0.59), ketamine (0.52, 0.46 to 0.57), or non-steroidal anti-inflammatory drugs (0.67, 0.49 to 0.91); and propofol emulsions containing medium and long chain triglycerides (0.75, 0.67 to 0.84). Statistical testing of indirect comparisons showed that use of the antecubital vein and pretreatment using lidocaine along with venous occlusion to be more efficacious than the other interventions. CONCLUSIONS: The two most efficacious interventions to reduce pain on injection of propofol were use of the antecubital vein, or pretreatment using lidocaine in conjunction with venous occlusion when the hand vein was chosen. Under the assumption of independent efficacy a third practical alternative could be pretreatment of the hand vein with lidocaine or ketamine and use of a propofol emulsion containing medium and long chain triglycerides. Although not the most effective intervention on its own, a small dose of opioids before induction halved the risk of pain from the injection and thus can generally be recommended unless contraindicated. http://www.bmj.com/highwire/filestream/346153/field_highwire_article_pdf/0.pdf   Estudio randomizado, controlado en un solo centro sobre el efecto de la dilución del propofol sobre el dolor en su sitio de inyección. A single-centre randomized-controlled trial to study effect of dilution on propofol-induced injection pain at injection site. Aggarwal S, Kumar M, Sharma V. Department of Anaesthesiology & Critical Care, University College of Medical Sciences, Guru Teg Bahadur Hospital, Shahdara, India. Saudi J Anaesth. 2011 Jul;5(3):282-5.  Abstract BACKGROUND: Propofol is a commonly used short-acting intravenous anaesthetic agent. A major disadvantage of propofol is pain at injection site with high incidence up to 90%. Various modalities have been tried to obtund propofol-induced pain; however, search for an ideal agent continues. We assessed the effect of double and triple dilution of 1% propofol emulsion with normal saline on pain at injection site. METHODS: This randomized, double-blinded study was done on 60 adult patients of both sexes, belonging to ASA grade I and II scheduled for elective surgery under general anesthesia, divided into three groups named I, II, III of 20 patients each. The patients of group I, II, and III received 1% propofol 2 ml, 0.5% propofol 4 ml, and 0.33% propofol 6 ml, respectively, over a period of 4 s and pain felt was assessed. RESULTS: There was no statistically significant difference in the pain score in group II as compared to patients in group I. However, there was a statistically significant decrease in the pain score in group III as compared to patients in group I (P value 0.02) and group II (P value 0.03). CONCLUSIONS: We found a significant decrease in both incidence and severity of pain during injection with a 0.33% propofol solution without significant adverse hemodynamic effects. The small size of data was a limitation in our study and a large-scale study will be needed to prove its therapeutic beneficence. http://www.saudija.org/article.asp?issn=1658-354X;year=2011;volume=5;issue=3;spage=282;epage=285;aulast=Aggarwal

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