Reduction of Propofol-Induced Pain through Pretreatment with Lidocaine and/or Flurbiprofen

Abstract

Objective: Pain is a well recognised complication of propofol injection. The purpose of this study was to compare the efficacy of flurbiprofen, lidocaine and a combination of the two in reducing pain on injection of propofol.

Design: Prospective, randomised, double-blind, placebo-controlled study.

Setting: University hospital in Tsukuba City, Japan.

Patients and interventions: 120 patients, 56 males and 64 females, aged 20-66 years, scheduled for elective plastic surgery were included. Patients received intravenously either lidocaine 20mg, flurbiprofen 50mg, both, or placebo (saline) accompanied by manual venous occlusion for 2 minutes, followed by administration of propofol 2 mg/kg into a dorsal hand vein (n = 30 in each group). A blinded researcher asked each patient to evaluate the pain score (0 = none, 1 = mild, 2 = moderate, 3 = severe) during propofol injection.

Main outcome measures and results: The incidence and intensity of pain was less in patients receiving lidocaine (27%, pain score 0 [median]), flurbiprofen (43%, 0), or both (3%, 0) along with venous occlusion than in those receiving placebo (90%, 2) along with venous occlusion (p < 0.01). Combined lidocaine and flurbiprofen with venous occlusion was the most effective treatment (p < 0.05). No complications such as pain, oedema, wheal or flare response were observed at the injection sites within the first 24 hours after surgery.

Conclusion: Combined lidocaine 20mg and flurbiprofen 50mg along with venous occlusion for 2 minutes was very effective for reducing pain on injection of propofol in patients scheduled for elective plastic surgery.