Reduction of Pain on Injection of Propofol by Pretreatment with Ketamine and Lidocaine

Kim, Dong Yeon

Abstract

Background
s : There were many trials for the prevention of pain induced by the intravenous injection of propofol. However, any previous preventive techniques have not been completely satisfactory. The aim of this study was to compare the use of propofol pretreated with ketamine and lidocaine for the reduction of pain during the injection of propofol.
METHODS
Patients in the lidocaine pretreated group(n=25) received lidocaine 40 mg, followed one minute later by propofol(2 mg/kg). Patients in the ketamine pretreated group(n=25) had a BP cuff inflated to 50 mmHg above their,s own systolic pressure and received ketamine 20 mg and the cuff was released one minute later, followed by the injection of propofol(2 mg/kg). Pain on injection of propofol was assessed verbally into none, mild, moderate and severe by the same observer. Blood pressure and heart rate before pretreatment injection and one minute after propofol injection were recorded. Any untoward effects of drugs were recorded.
RESULTS
There was a significant reduction in the incidence and severity of pain in the ketamine pretreated group. Only 7 patients(28%) in the ketamine group experienced pain as compared to 18 patients (72%) in the lidocaine pretreated group. Systolic pressure at one minute after propofol injection was significantly reduced in the lidocaine pretreated group. In the ketamine pretreated group systolic pressure at one minute after propofol injection was not reduced. No post-operative hallucinations or bad dreams were reported in any patients.
CONCLUSIONS
Prior to propofol intravenous injection, pretreatment with ketamine 40 mg after inflation of a BP cuff 50 mmHg above systolic pressure significantly reduces vascular pain without complications compare to pretreated with lidocaine 40 mg.