Management of pain during injection of propofol

The results of this narrative review and published systematic reviews suggest that to reduce the risk of pain during injection with propofol one should use alipid emulsion of propofol, injected into a large vein, preceded by lidocaine 0.5mg/kg with venous compression for 30-120 s. The addition of other compounds can also be recommended, and ketamine 0.4mg/kg (adult dose) may be the additional drug of choice, particularly because the combination of ketamine and propofol (ketofol) has added therapeutic benefits. In children Emla cream is an option, but to be effective it must be applied about 4 h before propofol is injected. Propofol-induced pain Propofol is a short-acting intravenous induction agent,given by bolus injection in general anesthesia and by infusion in ICUs. Its rapid onset of action, short half-life,and favorable recovery characteristics make it suitable for day procedures, such as gastrointestinal endoscopy.The most common adverse reaction to propofol is pain on injection. The incidence can be as high as 70% or more.1 Mechanism The mechanism of propofol-induced pain is not known.It may involve the generation of bradykinin, although there are conflicting results.2,3 The pH of the injected solution may be relevant, as the addition of lidocaine is effective and reduces the pH of propofol solutions,thereby reducing the concentration of propofol in the aqueous phase4; however, in one study when the lidocaine was alkalinized with sodium bicarbonate there was an additional. © 2014 Lippincott Williams and Wilkins.