Effect of Intravenous Dexamethasone on Propofol Injection Pain: A Randomized Placebo Controlled Study

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexamethasone group than the saline group (p<0.05). The incidence of mild and moderate pain in dexamethasone groups versus saline group was 30% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with intravenous dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain on propofol injection (POPI).

[1]  S. Salimi,et al.  Comparison the Effect of Granisetron and Dexamethasone on Intravenous Propofol Pain , 2018, Advanced biomedical research.

[2]  S. Davidge,et al.  Propofol Increases Vascular Relaxation in Aging Rats Chronically Treated with the Angiotensin-Converting Enzyme Inhibitor Captopril , 2013, Anesthesia and analgesia.

[3]  R. McCarthy,et al.  Dexamethasone to Prevent Postoperative Nausea and Vomiting: An Updated Meta-Analysis of Randomized Controlled Trials , 2013, Anesthesia and analgesia.

[4]  A. Perez,et al.  Ketamine Activates the l-Arginine/Nitric Oxide/Cyclic Guanosine Monophosphate Pathway to Induce Peripheral Antinociception in Rats , 2011, Anesthesia and analgesia.

[5]  R. Marcus,et al.  Dose ranging study on the effect of preoperative dexamethasone on postoperative quality of recovery and opioid consumption after ambulatory gynaecological surgery. , 2011, British journal of anaesthesia.

[6]  Seref Otelcioglu,et al.  Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol , 2010, European journal of anaesthesiology.

[7]  H. Ayoğlu,et al.  Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? , 2007, European journal of anaesthesiology.

[8]  A. Tyagi,et al.  Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain. , 2005, European journal of anaesthesiology.

[9]  K. Sobue,et al.  Profound pain due to propofol injection triggered myocardial ischemia in a patient with a suspected pheochromocytoma. , 2003, Anesthesia and analgesia.

[10]  M. Tramèr,et al.  Prevention of Pain on Injection with Propofol: A Quantitative Systematic Review , 2000, Anesthesia and analgesia.

[11]  M. Nakane,et al.  A potential mechanism of propofol-induced pain on injection based on studies using nafamostat mesilate. , 1999, British journal of anaesthesia.

[12]  P. Dubey,et al.  Ondansetron pretreatment to alleviate pain on propofol injection: a randomized, controlled, double-blinded study. , 1999, Anesthesia and analgesia.

[13]  W. Pang,et al.  The Analgesic Effect of Fentanyl, Morphine, Meperidine, and Lidocaine in the Peripheral Veins: A Comparative Study , 1998, Anesthesia and analgesia.

[14]  J. Brock‐Utne,et al.  Reduction of propofol injection pain with a double lumen i.v. set. , 1997, Journal of clinical anesthesia.

[15]  J. Esplugues,et al.  Role of the Endothelium in the Relaxation Induced by Propofol and Thiopental in Isolated Arteries from Man , 1997, The Journal of pharmacy and pharmacology.

[16]  S. Ralston,et al.  Nitric oxide production in cells derived from the human joint. , 1996, British journal of rheumatology.

[17]  J. Arndt,et al.  Nitric oxide as a chemical link in the generation of pain from veins in humans , 1996, Pain.

[18]  T. W. Lee,et al.  Pain during injection of propofol , 1994, Anaesthesia.

[19]  J. Pearson,et al.  Propofol stimulates nitric oxide release from cultured porcine aortic endothelial cells , 1993, British journal of pharmacology.

[20]  R. Johns,et al.  Effects of propofol and thiopental in isolated rat aorta and pulmonary artery. , 1992, Anesthesiology.

[21]  J. Fee,et al.  Pain on injection of propofol: comparison of lignocaine with metoclopramide. , 1992, British journal of anaesthesia.

[22]  E. J. Wells,et al.  Lidocaine for the Prevention of Pain Due to Injection of Propofol , 1992, Anesthesia and analgesia.

[23]  King Sy,et al.  Lidocaine for the prevention of pain due to injection of propofol. , 1992 .

[24]  P. Murphy,et al.  Effect of prior administration of cold saline on pain during propofol injection , 1991, Anaesthesia.

[25]  A. Mccrirrick,et al.  Pain on injection of propofol: the effect of injectate temperature , 1990, Anaesthesia.

[26]  D. Stokes,et al.  Effect of diluting propofol on the incidence of pain on injection and venous sequelae. , 1989, British journal of anaesthesia.

[27]  J Norman,et al.  Propofol: clinical strategies for preventing the pain of injection , 1988, Anaesthesia.

[28]  R. McCarthy,et al.  The Effect of Intravenous Dexamethasone and Lidocaine on Propofol-Induced Vascular Pain: A Randomized Double-Blinded Placebo-Controlled Trial , 2013 .

[29]  D. Yates,et al.  Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients. , 1996, American journal of respiratory and critical care medicine.