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BJA Advance Access published online on June 20, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen169
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Avoiding propofol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study

A. Rochette1,*, A. F. Hocquet1, C. Dadure1, D. Boufroukh1, O. Raux1, J. F. Lubrano1, S. Bringuier1,2 and X. Capdevila1

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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E-letters:

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Injection pain due to propofol in children and the ethics of placebo
Neil S. Morton
British Journal of Anaesthesia, 31 Aug 2008 [Full text]
Ethics is everyone's business
Gordon B Drummond
British Journal of Anaesthesia, 5 Sep 2008 [Full text]

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