BJA Advance Access originally published online on June 20, 2008
British Journal of Anaesthesia 2008 101(3):390-394; doi:10.1093/bja/aen169
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Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study
1 Department of Anaesthesia and Intensive Care ‘A’, Hôpital Lapeyronie, Montpellier, France
2 Department of Medical Statistics, Hôpital A. De Villeneuve, CHU de Montpellier, 371 Av. du doyen G. Giraud, 34295 Montpellier Cedex 5, France
* Corresponding author. E-mail: a-rochette{at}chu-montpellier.fr
Background: Pain on injection limits the use of propofol in children. The combination of lidocaine and propofol is widely used to reduce pain. A new solvent [medium-chain triglyceride (mct)/long-chain triglyceride (lct)] has been advocated to be less painful than standard (lct) propofol in adults, but no information is available of its usefulness in pre-school children. We designed a prospective, randomized, double-blinded, placebo-controlled study to assess injection pain with two different propofol emulsions, each given with or without lidocaine in children <7 yr.
Methods: A total of 160 ASA I–III children were randomly assigned to receive lct–propofol or mct/lct–propofol, 5 mg kg–1, with lidocaine 10 mg ml–1 or saline. The site and size of venous cannulation and restlessness before injection were recorded in each patient. A pain score graded 0–6 was established based on spontaneous verbal and motor reaction during injection, each graded 0–3. Kruskall–Wallis and Mann–Whitney tests were used for statistical analysis.
Results: Median pain scores decreased in all groups compared with lct–propofol–saline (P<0.001) and were least in the lct/mct–propofol–lidocaine group (P<0.001). Painless injection (score, 0–2) occurred in 92.5% of patients in the mct/lct–propofol–lidocaine group compared with 41–77% in the others (P<0.001).
Conclusions: Mct/lct–propofol caused significantly less pain than lct–propofol in preschool children. Mixing of lidocaine with mct/lct–propofol resulted in a further significant decrease, virtually eliminating the pain on injection.
Keywords: anaesthesia, paediatric; anaesthetic techniques, i.v. bolus; anaesthetics i.v., propofol; pain, injection; solubility, lipid
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  H. J. Kwak, S. K. Min, J. S. Kim, and J. Y. Kim Prevention of propofol-induced pain in children: combination of alfentanil and lidocaine vs alfentanil or lidocaine alone Br. J. Anaesth., September 1, 2009; 103(3): 410 - 412. [Abstract] [Full Text] [PDF]
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N. S. Morton, G. B. Drummond, A. Rochette, and X. Capdevila Injection pain due to propofol in children and the ethics of placebo Br. J. Anaesth., December 1, 2008; 101(6): 878 - 879. [Full Text] [PDF]
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