Efficacy of prophylactic intravenous ondansetron for attenuation of pain on propofol injection

Introductions: Propofol is a popular intravenous anesthetic agent. One disadvantage of propofol is pain on its injection which can be excruciating at times. Various agents and methods have been tried to attenuate this unpleasant effect. Ondansetron, primarily used as an antiemetic has also been studied to reduce it. Methods: This randomized, prospective, double-blinded, placebo-controlled study was conducted on patients of either sex, American Society of Anesthesiologists (ASA) physical status I & II, undergoing elective surgeries requiring general anesthesia. The patients were randomly divided into ondansetron (A, received intravenous ondansetron 4 mg) and placebo (B, received equivalent volume of normal saline) groups. Manual occlusion of venous drainage was done at mid-arm by an assistant for 1 minute after which 25% of the calculated dose (2 mg/kg) of propofol (1% w/v in lipid base) was injected. Patients were asked by a blinded investigator to score the pain on injection of propofol on 4-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain and compared in between two groups. The p<0.05 was considered significant. Results: There were 96 adult patients, 48 in each group of Ondansetron placebo. Pain on propofol injection was found significantly higher in the placebo group compared to the ondansetron group. (62.5% vs 35.4%). Most of the patients in the ondansetron group had mild pain only, whereas, a significant number of patients in the placebo group had higher degrees of pain on propofol injection. Conclusions: Prophylactic intravenous 4 mg ondansetron is a safe and simple method of attenuating pain on propofol injection.

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Management of Pain During Propofol Injection Using Intravenous Nitroglycerine

KYAMC Journal ◽

10.3329/kyamcj.v10i4.45720 ◽

2020 ◽

Vol 10 (4) ◽

pp. 202-205

Author(s):

Muhammad Sazzad Hossain ◽

Mohammad Mamunur Rashid ◽

Md Anisur Rahman Babu ◽

Afsana Sultana ◽

Md Sirajul Islam Mahfuz ◽

...

Keyword(s):

Placebo Group ◽

Venous Occlusion ◽

Saline Group ◽

Injection Pain ◽

Group A ◽

American Society ◽

Group B ◽

Double Blinded ◽

American Society Of Anesthesiologists ◽

To Receive

Background: Propofol is an intravenous (IV) anesthetic agent, can irritate the skin, mucous membrane and venous intima. The main drawback is the pain at injection site following its intravenous injection. Objectives: This study was performed to evaluate the effect of intravenous nitroglycerine on pain in patients following propofol injection. Materials and Methods: Eighty adult patients of both sexes, aged 20-50 years, according to American Society of Anesthesiologists (ASA) physical status were divided into two equal groups (n=40) to receive 200 mcg intravenous nitroglycerine diluted in 10 ml saline (group A) and 10 ml normal saline as placebo (group B) at an ambient operating room temperature in a randomized and double blinded fashion to compare the pain-relieving effects of the drugs during propofol injection before the patients lost consciousness. The pain on propofol injection was assessed according to the Mc Crirrick and Hunter scale. Results: The overall incidence and severity of pain were significantly less in Groups A (nitroglycerine group) than group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 25% vs 45% and 15% vs 30% respectively (p<0.05). The incidence of score '0' (no pain) was higher in Group A (60%) than Group B (25%) (p<0.05). Conclusion: Pretreatment with 200 mcg nitroglycerine with venous occlusion for one minute is effective pretreatment in alleviating propofol injection pain when compared to placebo. KYAMC Journal Vol. 10, No.-4, January 2020, Page 202-205

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EFFECT OF DEXMEDETOMIDINE ON DOSE REQUIREMENT OF PROPOFOL AND THIOPENTONE INDUCTION IN PATIENTS UNDER GENERAL ENDOTRACHEAL ANESTHESIA

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i6.25198 ◽

2018 ◽

Vol 11 (6) ◽

pp. 262

Author(s):

Laxman K Senapati ◽

Priyadarsini Samanta

Keyword(s):

Saline Infusion ◽

Controlled Study ◽

Control Group ◽

Dose Requirement ◽

Preanesthetic Medication ◽

American Society ◽

Double Blinded ◽

American Society Of Anesthesiologists ◽

Dexmedetomidine Infusion ◽

Endotracheal Anesthesia

Objectives: The present study was undertaken to assess the effect of dexmedetomidine as a premedicant on dose requirement of induction agents, thiopentone and propofol in patients undergoing various surgeries under general endotracheal anesthesia under the bispectral index (BIS) guidance.Methods: A double-blinded randomized controlled study was conducted during the year 2014–2015 among 120 patients aged 18–55 years with American Society of Anesthesiologists’ physical status Score I or II and Mallampati Grades I and II. After obtaining informed consent, all the eligible patients were randomly assigned to one of the four groups each containing 30 patients: Group SP (control group) - saline infusion before induction with propofol, group DP - dexmedetomidine infusion before induction with propofol, group ST (control group) - saline infusion before induction with thiopentone, and group DT - dexmedetomidine infusion before induction with thiopentone.Results: The mean dose of propofol required was 95.0±6.15 mg and 55.0±7.0 mg in group SP and DP, respectively, whereas the requirement of thiopentone was 6.6±0.93 mg/kg in group ST as opposed to 4.8±0.58 mg/kg in group DT. The decrease in the dose requirement in dexmedetomidine groups than the control groups was statistically significant and also dose reduction in dexmedetomidine was more in DP group compared to that in DT group (p<0.001).Conclusion: Dexmedetomidine as a preanesthetic medication significantly decreases intraoperative anesthetic requirement of thiopentone and propofol, and dose requirement is significantly less in case of propofol as compared to thiopentone.

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Use of Dexmedetomidine for Preventing Pain on Propofol Injection: A Double Blinded Placebo Controlled Study

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v10i2.44130 ◽

2019 ◽

Vol 10 (2) ◽

pp. 164-168

Author(s):

Muhammad Sazzad Hossain ◽

Md Afzalur Rahman ◽

Md Mahiuddin Alamgir ◽

Md Waliullah ◽

Paresh Chandra Sarker ◽

...

Keyword(s):

General Anesthesia ◽

Randomized Study ◽

Venous Occlusion ◽

Saline Group ◽

Controlled Study ◽

Medical College ◽

Elective Surgical Procedure ◽

American Society ◽

Double Blinded ◽

American Society Of Anesthesiologists

Background and aim of study: Propofol is a commonly used drug for general anesthesia. It can irritate the skin, mucous membrane and venous intima. The main drawback is the pain during intravenous injection. Aim of this prospective randomized study is to observe the efficacy of intravenous dexmedetomidine as pretreatment for the prevention of pain caused by the propofol injection. Methods: A total of 80 adult patients were selected in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, scheduled for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group received 0.25 mcg of intravenous dexmedetomidine in 5 ml. Group II (placebo group) received 5 ml of 0.9% intravenous normal saline one minute before injection of propofol. The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexmedetomidine group was 35% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexmedetomidine group than the saline group (p<0.05). The incidence of mild and moderate pain in dexmedetomidine groups versus saline group was 20% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with 0.25 mcg/kg of dexmedetomidine with venous occlusion for one minute, effectively reduces pain on propofol injection. Anwer Khan Modern Medical College Journal Vol. 10, No. 2: July 2019, P 164-168

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Patient-Controlled Epidural Levobupivacaine with or without Fentanyl for Post-Cesarean Section Pain Relief

BioMed Research International ◽

10.1155/2014/965152 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Shin-Yan Chen ◽

Feng-Lin Liu ◽

Yih-Giun Cherng ◽

Shou-Zen Fan ◽

Barbara L. Leighton ◽

...

Keyword(s):

Cesarean Section ◽

Epidural Analgesia ◽

University Hospital ◽

Control Regimen ◽

Background Infusion ◽

Continuous Background ◽

American Society ◽

Group B ◽

Double Blinded ◽

American Society Of Anesthesiologists

Purpose.The purpose of this study was to compare the analgesic properties of levobupivacaine with or without fentanyl for patient-controlled epidural analgesia after Cesarean section in a randomized, double-blinded study.Methods.We enrolled American Society of Anesthesiologists class I/II, full-term pregnant women at National Taiwan University Hospital who received patient-controlled epidural analgesia after Cesarean section between 2009 and 2010. Eighty women were randomly assigned into two groups. In group A, the 40 subjects received drug solutions made of 0.6 mg/ml levobupivacaine plus 2 mcg/ml fentanyl, and in group B the 40 subjects received 1 mg/ml levobupivacaine. Maintenance was self-administered boluses and a continuous background infusion.Results.There were no significant differences in the resting and dynamic pain scales and total volume of drug used between the two groups. Patient satisfaction was good in both groups.Conclusion.Our study showed that pure epidural levobupivacaine can provide comparative analgesic properties to the levobupivacaine-fentanyl combination after Cesarean section. Pure levobupivacaine may serve as an alternative pain control regimen to avoid opioid-related adverse events in parturients.

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Reliable and rapid smooth extubation after Ketofol for induction of general anesthesia in Laparoscopic Drilling of polycystic ovary: A randomized controlled trial

10.21203/rs.3.rs-29085/v1 ◽

2020 ◽

Author(s):

Atef Mohamed Sayed Mahmoud ◽

Joseph Makram Botros ◽

Safaa Gaber Ragab

Keyword(s):

General Anesthesia ◽

Polycystic Ovary ◽

Controlled Trial ◽

Controlled Study ◽

Double Blind ◽

Randomized Controlled ◽

Airway Response ◽

American Society ◽

American Society Of Anesthesiologists ◽

Better Than

Abstract Background the outcome of ketofol on the hemodynamics and the airway response during induction of general anesthesia has been studied before. Its effect on smoothness of extubation has not been studied before. So, we aimed to assess the effect of ketofol on the smoothness of extubation and compare it with propofol only for induction of general anesthesia. Methods This double-blind, randomized, and controlled study was conducted on one hundred and six American Society of Anesthesiologists Physical status ''ASA PS'' class I and II female patients aged 18–40 years old and scheduled for laparoscopic drilling for polycystic ovary disease under general anesthesia. The patients were assigned into one of two groups (53) patients each; group KP = ketofol and group P = propofol. Results There was good sedation score during suction and extubation in the ketofol group. Airway response and smoothness of extubation were better in the ketofol group better than the propofol group. Conclusion Ketofol as an induction anesthetic agent was effective in attenuating the airway response during extubation more than profofol only. Trial registration: This trial was retrospectively registered at the Clinical Trial.gov with the Identification Number: NCT04365686.

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Ubiquinone Supplementation with 300 mg on Glycemic Control and Antioxidant Status in Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial

Antioxidants ◽

10.3390/antiox9090823 ◽

2020 ◽

Vol 9 (9) ◽

pp. 823

Author(s):

Chien-Chang Ho ◽

Po-Sheng Chang ◽

Hung-Wun Chen ◽

Po-Fu Lee ◽

Yun-Chi Chang ◽

...

Keyword(s):

Placebo Group ◽

Glycemic Control ◽

Antioxidant Capacity ◽

Controlled Trial ◽

Controlled Study ◽

Model Assessment ◽

Glycemic Profile ◽

Homeostatic Model Assessment ◽

Total Antioxidant ◽

Double Blinded

The aim of this study is to investigate the glycemic profile, oxidative stress, and antioxidant capacity in athletes after 12 weeks of ubiquinone supplementation. It was a double-blinded, randomized, parallel, placebo-controlled study. Thirty-one well-trained college athletes were randomly assigned to ubiquinone (300 mg/d, n = 17) or placebo group (n = 14). The glycemic profile [fasting glucose, glycated hemoglobin (HbA1c), homeostatic model assessment-insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI)], plasma and erythrocyte malondialdehyde (MDA), total antioxidant capacity (TAC), and ubiquinone status were measured. After supplementation, the plasma ubiquinone concentration was significantly increased (p < 0.05) and the level of erythrocyte MDA was significantly lower in the ubiquinone group than in the placebo group (p < 0.01). There was a significant correlation between white blood cell (WBC) ubiquinone and glycemic parameters [HbA1c, r = −0.46, p < 0.05; HOMA-IR, r = −0.67, p < 0.01; QUICKI, r = 0.67, p < 0.01]. In addition, athletes with higher WBC ubiquinone level (≥0.5 nmol/g) showed higher erythrocyte TAC and QUICKI and lower HOMA-IR. In conclusion, we demonstrated that athletes may show a better antioxidant capacity with higher ubiquinone status after 12 weeks of supplementation, which may further improve glycemic control.

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Effect of Intravenous Dexamethasone on Propofol Injection Pain: A Randomized Placebo Controlled Study

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i1.45192 ◽

2020 ◽

Vol 25 (1) ◽

pp. 28-33

Author(s):

Muhammad Sazzad Hossain ◽

Md Afzalur Rahman ◽

Mamunur Rashid ◽

Monirul Islam ◽

Anisur Rahman Babu ◽

...

Keyword(s):

Normal Saline ◽

Saline Group ◽

Controlled Study ◽

Injection Pain ◽

Moderate Pain ◽

Dexamethasone Group ◽

Group I ◽

Elective Surgical Procedure ◽

American Society ◽

American Society Of Anesthesiologists

Background and aim of study: Pain on propofol injection (POPI) is a common problem. None of the commonly used methods completely attenuate the pain. Inflammatory response to propofol contributes to the pain. This study was conducted to compare the efficacy of dexamethasone in attenuation of pain following intravenous injection of propofol. Materials and methods: A total of 80 adult patients were scheduled in this study with either sex, ASA (American Society of Anesthesiologists) grade I and II, for routine elective surgical procedure under general anesthesia. The patients enrolled were divided randomly into two groups of 40 patients each. Group I received 0.15 mg/kg of intravenous dexamethasone in 5 ml normal saline and Group II (placebo group) received 5 ml of 0.9% intravenous normal saline, following exsanguination and occlusion of the vein of the arm. This was followed by 0.5 mg/kg of propofol intravenously.The patients were asked to report their pain during injection of propofol according to the McCririck and Hunter scale. Results: The incidence of pain experienced in dexamethasone group was 45% patients and in saline group was 70% patients (p<0.05). The severity of POPI was also lower in dexamethasone group than the saline group (p<0.05). The incidence of mild and moderate pain in dexamethasone groups versus saline group was 30% versus 45% and 15% versus 25% respectively p<0.05. There was no severe pain recorded in any groups. Conclusion: Pretreatment with intravenous dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain on propofol injection (POPI). Bangladesh J Otorhinolaryngol; April 2019; 25(1): 28-33

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Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

Anesthesiology ◽

10.1097/00000542-200507000-00008 ◽

2005 ◽

Vol 103 (1) ◽

pp. 25-32 ◽

Cited By ~ 570

Author(s):

Vadim Nisanevich ◽

Itamar Felsenstein ◽

Gidon Almogy ◽

Charles Weissman ◽

Sharon Einav ◽

...

Keyword(s):

Body Weight ◽

Hospital Stay ◽

Fluid Management ◽

Postoperative Outcome ◽

Protocol Group ◽

Number Of Patients ◽

Secondary Endpoints ◽

American Society ◽

American Society Of Anesthesiologists ◽

The Impact

Background The debate over the correct perioperative fluid management is unresolved. Methods The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days. Results The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG. Conclusions In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

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Analgesic effects of lornoxicam after total abdominal hysterectomy

Journal of Opioid Management ◽

10.5055/jom.2007.0053 ◽

2007 ◽

Vol 3 (3) ◽

pp. 155 ◽

Cited By ~ 12

Author(s):

Ozgur Sapolya, MD ◽

Beyhan Karamanlhoglu, MD ◽

Dilek Memis, MD

Keyword(s):

Placebo Group ◽

Gas Flow ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Analgesic Effects ◽

Number Of Patients ◽

Sedation Scores ◽

Double Blinded ◽

Length Of Hospitalization ◽

Incremental Dose

The authors investigated, in a randomized, placebocontrolled, double-blinded study, the efficacy and safety of lornoxicam on pain after abdominal hysterectomy and on tramadol consumption in patients. Fifty patients were randomized to receive either oral placebo or lornoxicam 8 mg one hour before surgery. Anesthesia was induced with propofol and maintained with sevoflurane in 50 percent N2O/O2 with a fresh gas flow of 2 L/min (50percent N2O in O) and fentanyl (2 fig/kg). All patients received patient-controlled analgesia with tramadol with loading dose of 50 mg; incremental dose of 20 mg; lock out interval of 10 minute; and four-hour limit 300 mg. The incremental dose was increased to 30 mg if analgesia was inadequate after one hour. Patients were studied at one, two, four, eight, 12, and 24 hours for visual analogue (VAS) pain scores, heart rate, mean arterial pressure, periferic oxygen saturation, sedation, tramadol consumption, and length of hospitalization. VAS scores at one hour were significantly lower in the lornoxicam group (p < 0.001). The tramadol consumption at one, two, four, eight, and 12 hours was significantly lower in the lornoxicam group when compared with the placebo group (p < 0.001, p = 0.008, p = 0.029, p = 0.034, p = 0.042, respectively). Sedation scores were similar at all the measured times in the groups. Length of hospitalization was significantly shorter in lornoxicam group (4.8 ± 0.4 day) than placebo group (5.2 ± 0.5 day) (p = 0.005). There was difference in the incidence of nausea between the groups (p = 0.047). The number of patients and the doses ofantiemetics given during the first 24 hours after surgery in lornoxicam group were less than those in placebo group (p = 0.003, p = 0.034, respectively).In conclusion, a single oral dose of lornoxicam given preoperatively enhanced the analgesic effect of tramadol, decreasing tramadol consumption and side effects, and shortened the length of hospitalization.

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A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

10.21203/rs.3.rs-944545/v1 ◽

2021 ◽

Author(s):

Wirat Wasinwong ◽

Sarocha Termthong ◽

Prae Plansangkate ◽

Jutarat Tanasansuttiporn ◽

Riam Kosem ◽

...

Keyword(s):

Primary Outcome ◽

Elective Surgery ◽

Controlled Study ◽

Injection Pain ◽

Syringe Pump ◽

Intravenous Catheter ◽

Randomized Controlled ◽

American Society ◽

American Society Of Anesthesiologists ◽

Median Pain

Abstract Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

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