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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2012, Number 3

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An Med Asoc Med Hosp ABC 2012; 57 (3)

Ondansetron versus lidocaine for the prevention of pain associated with the administration of propofol during induction

García JL, Montoya T, Valdez-Ortiz R, Añorve I, Covarrubias VJA, De Los Santos F, García M, Cruz J

Language: Spanish
References: 30
Page: 210-216
PDF size: 68.87 Kb.


ABSTRACT

Introduction: Pain with the intravenous administration of propofol is a frequent complication during induction in awake patients with an incidence that varies between 28 and 90%. Despite multiple strategies it has not been possible to diminish this frequency. Ondansetron is an antiemetic that may have analgesic properties through 5HT3 receptors. Objective: To evaluate the efficacy of ondansetron pretreatment in diminishing pain with the intravenous administration of propofol during anesthetic induction. Materials and methods: A prospective, randomized, double blind study was performed. 34 patients scheduled for elective surgery under general anesthesia in the operating rooms of the ABC Medical Center were included. Before intravenous administration of propofol, patients were randomly assigned in one of two groups: patients in group (L) received 2 ml of lidocaine and patients in group (O) received 2 ml of ondansetron. Pain was then graded with the use of a four grade Visual Analog Scale. Results were analyzed with SPSS version 15.0 statistics software. Results: 17 patients were included in each of the 2 groups. There were no significant differences in demographics, comorbidities and physical ASA status between both groups. The comparison of pain incidence using the Visual Analog Scale showed in group (L) 3 patients a with score of 0 (18%), 6 patients with 1 (35%), 7 patients with 2 (41%) and 1 patient with 3 (6%). In group (O) there were 3 patients with a score of 0 (18%), 7 patients with 1 (41%), 4 patients with 2 (23%) and 3 patients with 3 (18%). There were no significant differences between both groups. Conclusion: The use of ondansetron before intravenous administration of propofol during induction is as efficient as lidocaine in diminishing pain with the injection of this drug.


REFERENCES

  1. Baker, M. Propofol. The challenges of formulation. Anesthesiology 2005; 103: 860-876.

  2. White P. Propofol: its role in changing the practice of anesthesia. Anesthesiology 2008; 109: 1132-1136.

  3. Trapani G, Altomare C, Sanna E et al. Propofol in Anesthesia. Mechanism of action, structure activity relationships, and drug delivery. Curr Med Chem 2000; 7: 249-271.

  4. Reves J, Glass P, Lubarsky D, Mceyoy M. Intravenous nonopioid anesthetics, In; Miller RD, editor. Miller´s Anesthesia. Philadelphia: Elsevier Churchill Livingstone; 2005: 323-324.

  5. Local Anesthetics. En: Stoelting RK, Hillier SC. Editors. Pharmacology and Physiology in Anesthetic. Practice. 4a Edicion. Lippincott Williams & Wilkins; 2006: 155-163.

  6. Macario A, Weinger M, Truong P et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999; 88: 1085-1091.

  7. Tan C, Onsiong M. Pain on injection of propofol. Anaesthesia 1998; 53: 468-476.

  8. Nathanson M, Gajraj N, Russell J. Prevention of pain on injection of propofol: A comparison of lidocaine with alfentanil. Anesth Analg 1996; 82: 469-471.

  9. Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br J Anaesth 1991; 67: 281-284.

  10. McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesthesia 1990; 45: 443-444.

  11. Picard P, Tramer M. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963-969.

  12. Agarwal A, Ansari M, Gupta D et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg 2004; 98: 683-686.

  13. Koo SW, Cho SJ, Kim YK et al. Small dose ketamine reduces the pain of propofol injection. Anesth Analg 2006; 103: 1444-1447.

  14. Cheong M, Kim K, Choi W. Ephedrine reduces the pain from propofol injection. Anesth Analg 2002; 95: 1293-1296.

  15. Liaw W, Pang W, Chang DP et al. Pain on injection of propofol: the mitigating influence of metoclopramide using different techniques. Acta Anesthesiol Scand 1999; 43: 24-27.

  16. Huang Y, Buerkle H, Lee C et al. Effect of pretreatment with ketorolac on propofol injection pain. Acta Anesthesiol Scand 2002; 46: 1021-1024.

  17. Apiliogullari S, Keles B, Apiliogullari B et al. Comparison of diphenhydramine and lidocaine for prevention of pain after injection of propofol: a double blind, placebo-controlled, randomized study. Eur J Anaesth 2007; 24: 235-238.

  18. Memis D, Turan A, Karamanlioglu B et.al. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg 2002; 95: 606-608.

  19. Ishiyama T, Kashimoto S, Oguchi T et al. Clonidine-ephedrine combination reduces pain on injection of propofol and blunts hemodynamic stress responses during the induction sequence. J Clin Anesth 2006; 18: 211-215.

  20. Iyilikci L, Balkan B, Gokel E et al. The effects of alfentanil or remifentanil pretreatment on propofol injection pain. J Clin Anesth 2004; 16: 499-502.

  21. Reddy M, Chen F, Ng H. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: A randomized controlled comparison with lidocaine. Anaesthesia 2001; 56 (9): 902-905.

  22. Memis D, Turan A, Karamanlioglu B et al. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesth 2002; 19: 47-51.

  23. Kovac A. Prophylaxis of postoperative nausea and vomiting: Controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists. J Clin Anesth 2006; 18: 304-318.

  24. Thompson A, Lummis S. The 5-HT3 receptor as a therapeutic target. Expert Opin Ther Targets 2007; 11 (4): 527-540.

  25. Spasov A, Chernikov M, Kiabiya S. Analgesic activity of 5-HT3 receptor antagonists. Bull Exp Biol Med 2005: 139 (4): 424-426.

  26. McCulloch M, Lees N. Assessment and modification of pain on induction with propofol (Diprivan). Anaesthesia 1985; 40: 1117-1120.

  27. McDonald D, Jameson P. Injection pain with propofol: reduction with aspiration of blood. Anaesthesia 1996; 51: 878-880.

  28. Aouad M, Siddik-Sayyid S, Al-Alami A et al. Multimodal analgesia to prevent propofol induced pain: pretreatment with remifentanil and lidocaine versus remifentanil and lidocaine alone. Anesth Analg 2007; 104: 1540-1544.

  29. Sasaki T, Okamura S, Kisara A et al. Effect of lidocaine on pain caused by injection of propofol. Comparison of three methods at two injection rates. J Clin Anesth 1999; 13: 14-16.

  30. Ambesh S, Dubey P, Sinha P. Ondansetron pretreatment to alleviate pain on propofol injection: A randomized, controlled, double-blinded study. Anesth Analg 1999; 89: 197-199.




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