The Prevention of Propofol-induced Pain in the Pediatric Patients: Comparison among the Effects of Remifentanil, Lidocaine, and the Combination of Remifentanil and Lidocaine

Heo, Hyun Joo; Kim, Chi Hyo; Han, Jong In

Abstract

BACKGROUND: There is a high incidence of pain following injection of propofol, and many studies have been conducted to find a way of reducing this. The administration of lidocaine and recently, remifentanil has also been used for this purpose in adults, but has been only partially effective. Thus, the purpose of this study was to investigate the analgesic effect of remifentanil alone, the premixture of lidocaine and both remifentanil and lidocaine and to compare either treatment alone during propofol injection in dorsal hand-veins in the pediatric patients.
METHODS
In a randomized, double-blind, prospective trial, 120 pediatric patients were allocated to one of four groups (each n = 30) receiving normal saline, remifentanil (0.5microgram/kg), lidocaine (0.3 mg/kg) and remifentanil (0.5microgram/kg) plus lidocaine (0.3 mg/kg) as pretreatment, followed by injection of 2% propofol (3 mg/kg). Pain was assessed on a four-point scale (none, mild, moderate, severe) during propofol injection. Mean arterial blood pressure and heart rates were measured before and after propofol injection.
RESULTS
The remifentanil, lidocaine and remifentanil plus lidocaine groups showed significantly less frequent and intense pain than the normal saline group. There are no significant change of mean arterial blood pressure and heart rate except normal saline group. The remifentanil and remifentanil plus lidocaine groups provided more pain relief than the lidocaine group.
CONCLUSIONS
The combination of remifentanil and premixture of lidocaine with propofol is the most effective method to prevent propofol-induced pain with hemodynamic stability in the pediatric patients.