Pain on injection of propofol: The mitigating influence of metoclopramide using different techniques

• Published in: Acta anaesthesiologica Scandinavica Vol. 43; no. 1; pp. 24 - 27
• Main Authors: Liaw, W.-J., Pang, W.-W., Chang, D.-P., Hwang, M.-H.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01-01-1999; Blackwell
• Subjects: Adult; Analgesics - administration & dosage; Analgesics - therapeutic use; Analysis of Variance; Anesthetic; Anesthetic, intravenous: propofol; Anesthetics, Intravenous - administration & dosage; Anesthetics, Local - administration & dosage; antiemetic: metoclopramide; Biological and medical sciences; Chi-Square Distribution; Dopamine Antagonists - administration & dosage; Dopamine Antagonists - therapeutic use; Double-Blind Method; Drug Combinations; Drug toxicity and drugs side effects treatment; Female; Humans; Incidence; Injections, Intravenous - adverse effects; intravenous: propofol; Lidocaine - administration & dosage; local anesthetic: lidocaine; Male; Medical sciences; Metoclopramide - administration & dosage; Metoclopramide - therapeutic use; Miscellaneous (drug allergy, mutagens, teratogens...); Pain - etiology; Pain - prevention & control; Pain Measurement; pain: injection; Pharmacology. Drug treatments; Placebos; Propofol - administration & dosage; Sodium Chloride; Time Factors; Tourniquets; Tourniquet; Human; Intravenous administration; Toxicity; General anesthesia; Injection site; Metoclopramide; Local anesthetic; Prevention; Analgesia; Chemotherapy; Analgesic; Pain; General anesthetic; Benzamide derivatives; Organic amide; Application method; Propofol; Lidocaine; Comparative study
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.1999.430106.x

Background: Metoclopramide administered intravenously (iv) immediately before injection of propofol, after mixing with propofol, or after a rubber tourniquet for 1 min before propofol injection will reduce pain induced by propofol injection. In this study, these three different techniques in reducing propofol injection pain with metoclopramide were compared with lidocaine or saline to evaluate the most effective method in reducing propofol injection pain.
Methods: In a randomized, semi‐double‐blind treatment, 175 patients were included into this study. Patients in group A were pretreated with metoclopramide 10 mg iv before propofol (2 mg/kg) induction. Patients in group B were induced with a mixture of propofol and metoclopramide. Patients in group C were pretreated with metoclopramide iv with a rubber tourniquet on the arm for 1 min followed by propofol administration. Groups D and E were identical to group C except for the replacement of pretreatment with either lidocaine (40 mg) or saline, respectively.
Results: Groups A, C and D (with active pain prophylaxis) showed a significantly less incidence of pain than the saline control group (E) as propofol was injected. There was no significance difference between metoclopramide and lidocaine in reducing propofol injection pain using a tourniquet technique. The intensity of the propofol injection pain (verbal pain score) was stronger with saline as compared with the other groups.
Conclusions: We conclude that iv retention of metoclopramide with tourniquet is as good as lidocaine and may be a useful alternative for reducing pain on propofol injection.