Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-20T17:42:25.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Does dexmedetomidine reduce the injection pain due to propofol and rocuronium?

Published online by Cambridge University Press:  01 June 2007

H. Ayoğlu ,
H. Altunkaya ,
Y. Özer ,
O. Yapakçı ,
G. Çukdar  and
I. Özkoçak
H. Ayoğlu*
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
H. Altunkaya
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
Y. Özer
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
O. Yapakçı
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
G. Çukdar
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
I. Özkoçak
Affiliation:
Zonguldak Karaelmas University School of Medicine, Department of Anesthesiology and Reanimation, Zonguldak, Turkey
*
Correspondence to: Hilal Ayoğlu, Department of Anesthesiology and Reanimation, Zonguldak Karaelmas University School of Medicine, Bahcelievler mah. Gül sok. Örnekevler A Blok Kat 5 Da:18 67100 Site, Zonguldak, Turkey. E-mail: [email protected]; Tel: +90 532 7449324; Fax: +90 372 2610251
Get access

Summary

Background and objectives

This prospective, double-blind, randomized, placebo-controlled study was designed to determine the efficacy of dexmedetomidine compared with lidocaine in reducing the pain of propofol and rocuronium injection pain.

Methods

One hundred and fifty patients, scheduled for elective surgery with general anaesthesia, were divided into five groups: saline (Group 1), dexmedetomidine 0.25 μg kg−1 (Group 2), lidocaine 0.5 mg kg−1 (Group 3), dexmedetomidine 0.25 μg kg−1 plus lidocaine 0.25 mg kg−1 (Group 4) or dexmedetomidine 0.25 μg kg−1 plus lidocaine 0.5 mg kg−1 (Group 5) were administered at a rate of 0.5 mL s−1 after tourniquet application. The occlusion was released after 1 min and 5 mL of propofol was injected over 20 s. Pain was evaluated by use of a 10-point verbal analogue scale. Then, the rest of the induction dose of propofol, 3 mL of saline bolus and 0.6 mg kg−1 of rocuronium, was injected. The response to injection of rocuronium was assessed with a four-point scale (0–3).

Results

Groups 1 and 2 were found to have higher propofol injection pain scores than Groups 3, 4 and 5 (P < 0.05). When the study groups were compared according to the overall incidence of withdrawal movements due to rocuronium (⩾1 response) in Groups 1, 2, 3, 4 and 5, they were different (86.7%, 60%, 36.7%, 50% and 40%, respectively) (P < 0.05). Except Group 1, there was no significant difference between the groups according to incidence of withdrawal movement after rocuronium injection (P = 0.325).

Conclusions

Pretreatment with dexmedetomidine is not effective in reducing injection pain of propofol, but may attenuate the hand withdrawal associated to rocuronium, as lidocaine does.

Keywords

DEXMEDETOMIDINEPAIN, injectionPROPOFOLROCURONIUMLIDOCAINE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 541 - 545
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Nathanson, MH, Gajraj, NM, Russell, JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg 1996; 82: 469–471.Google ScholarPubMed
2.Scott, RP, Saunders, DA, Norman, J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492–494.CrossRefGoogle ScholarPubMed
3.Memis, D, Turan, A, Karamanlioglu, B, Pamukcu, Z, Kurt, I. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004; 98: 835–840.Google ScholarPubMed
4.Mantz, J. Dexmedetomidine. Drugs Today 1999; 35: 151–157.CrossRefGoogle ScholarPubMed
5.Mencke, T, Beerhalter, U, Fuchs-Buder, T. Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients. Acta Anaesthesiol Scand 2001; 45: 1002–1005.CrossRefGoogle ScholarPubMed
6.Morishima, T, Sobue, K, Arima, H et al. . Profound pain due to propofol injection triggered myocardial ischemia in a patient with a suspected pheochromocytoma. Anesth Analg 2003; 96: 631.Google Scholar
7.Liou, JT, Hsu, JC, Liu, FC, Ching-Wah Sum, D, Lui, PW. Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients. Anesth Analg 2003; 97: 1294–1297.CrossRefGoogle ScholarPubMed
8.Klement, W, Arndt, JO. Pain on intravenous injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations. Br J Anaesth 1991; 66: 189–195.Google Scholar
9.Cheong, KF, Wong, WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth 2000; 84: 106–107.Google Scholar
10.Lockey, D, Coleman, P. Pain during injection of rocuronium bromide. Anaesthesia 1995; 50: 474.CrossRefGoogle ScholarPubMed
11.Agarwal, A, Raza, M, Dhiraaj, S et al. . Pain during injection of propofol: the effect of prior administration of butarphanol. Anesth Analg 2004; 99: 117–119.Google Scholar
12.Pang, WW, Huang, PY, Chang, DP, Huang, MH. The peripheral analgesic effect of tramadol in reducing propofol injection pain: a comparison with lidocaine. Reg Anesth Pain Med 1999; 24: 246–249.Google Scholar
13.Ozkocak, I, Altunkaya, H, Ozer, Y, Ayoglu, H, Demirel, CB, Cicek, E. Comparison of ephedrine and ketamine in prevention of injection pain and hypotension due to propofol induction. Eur J Anaesthesiol 2005; 22: 44–48.Google Scholar
14.Doenicke, AW, Roizen, MF, Rau, J, Kellermann, W, Babl, J. Reducing pain during propofol injection: the role of the solvent. Anesth Analg 1996; 82: 472–474.Google ScholarPubMed
15.Yoshikawa, T, Wajima, Z, Ogura, A, Inoue, T, Ogawa, R. Orally administered clonidine significantly reduces pain during injection of propofol. Br J Anaesth 2001; 86: 874–876.CrossRefGoogle ScholarPubMed
16.Borgeat, A, Kwiatkowski, D. Spontaneous movements associated with rocuronium: is pain on injection the cause? Br J Anaesth 1997; 79: 382–383.Google Scholar
17.Turan, A, Memis, D, Kaya, G, Karamanlioglu, B. The prevention of pain from injection of propofol by dexmedetomidine and comparison with lidocaine. Can J Anaesth 2005; 52: 548–549.CrossRefGoogle ScholarPubMed
18.Eriksson, M, Englesson, S, Niklasson, F, Hartvig, P. Effect of lignocaine and pH on propofol-induced pain. Br J Anaesth 1997; 78: 502–506.CrossRefGoogle ScholarPubMed
19.Blunk, JA, Seifert, F, Schmelz, M, Reeh, PW, Koppert, W. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol 2003; 20: 245–253.Google Scholar
20.Joshi, GP, Whitten, CW. Pain on injection of rocuronium bromide. Anesth Analg 1997; 84: 228–236.CrossRefGoogle ScholarPubMed
21.Turan, A, Memis, D, Karamanlioglu, B, Sut, N, Pamukcu, Z. The prevention of pain from injection of rocuronium by magnesium sulphate, lignocaine, sodium bicarbonate and alfentanil. Anaesth Intens Care 2003; 31: 277–281.Google Scholar
22.Memis, D, Turan, A, Kaya, G, Karamanlioglu, B, Seker, S. Preventing pain on injection of rocuronium: two doses of dexmedetomidine. Can J Anaesth 2005; 52: 437–438.Google Scholar