OBJECTIVS: Propofol-induced pain injection occurs in 30-90 percent of patients. Various strategies have been advocate to minimize this nuisance with variable results. Lidocaine pretreatment is the most popular method for reducing this pain but this drug cannot entirely eliminate the problem. the purpose of this study was to compare the analgesic effect of lidocaine with thiopental and metoclopramide accompanied by venous occlusion.
METHODS: In a randomized, double-blinded, placebo-controlled trial, 144 ASA I-II patients, scheduled for elective surgery under general anesthesia were randomly assigned to 1 of 4 groups. Group I received 2 ml of plain NSS, group II received lidocaine 40 mg, group III received thiopental 0.5mg/kg and group IV received metoclopramide 10 mg. All pretreatment drugs were made into 2 ml solutions and were given IV with manual venous occlusion of 1 minute. Propofol was administered after release of venous occlusion. pain was then assessed using a four-point scale and face pain scale during propofol injection.
RESULTS: 36 patients (100%) complained of pain in the control group compared with 20 (56%), 22 (61%) and 23 (64%) in the lidocaine, thiopental and metoclopramide groups, respectively (p<0.05). there was no significant difference among the 3 test solution with regards to severity of pain. Nor were there any noted complications 24 hours postoperatively on the injection site.
CONCLUSION: Thiopental and metoclopramide are equally effective as lidocaine in reducing pain during propofol injection when used with manual venous occlusion.