Propofol Injection Pain

Pain with propofol injection occurs in majority of patients. Propofol injection pain can be reduced by the following methods explained here.

Propofol causes pain or discomfort on injection in 28% to 90% of awake patients. A number of techniques have been tried for minimizing propofol injection pain with variable results.

The propofol injection pain decreases when the drug is injected into a large vein rather than a dorsum vein on the hand.

The most frequently used method to reduce this pain is premixture with 1% lidocaine (20—40 mg). Prior administration of a potent short-acting opioid (Alfentanil 1 mg,  pretreatment with ketamine (100 microg/kg,889 small dose of ephedrine (30—70 microg/kg, also decreases the incidence of pain.

Various other drugs such as butorphanol, metoclopramide, flurbiprofen axetil, ondansetron, ketorolac are also tried. Recently, a modified lipid emulsion of propofol containing medium-chain triglycerides (MCT) with long-chain triglycerides (LCT), in contrast to the usual LCT formulation, has been advocated to alleviate pain.

The reason for less Pain with propofol injection with LCT/MCT propofol may be attributed to a decreased concentration of propofol in the aqueous phase.

Accidental intra-arterial injection produces hyperaemia around the injection site along with propofol injection pain at injection site. A temporary blanching appear distal to the injection site.95’96 Intra-arterial propofol is not directly toxic to vascular endothelium

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