British Journal of Anaesthesia, Vol 78, Issue 5 502-506, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Eriksson, S. Englesson, F. Niklasson and P. Hartvig
Propofol has the disadvantage of pain on injection. A higher partition of
propofol in the aqueous phase of the preparation causes a higher incidence
of pain on injection while addition of 1% lignocaine to propofol reduces
pain. The low concentration of this local anaesthetic and the rapid pain
relief observed indicates that mechanisms other than local anaesthesia are
involved, that is change in pH. We performed a clinical study to
investigate the influence of lignocaine and pH on pain during injection of
1% Diprivan. Ten parts of 1% Diprivan were mixed with one part of saline,
1% lignocaine or hydrochloric acid to achieve the same pH as that after
addition of lignocaine. Diprivan 1% mixed with 1% lignocaine and with
hydrochloric acid gave mean pain ratings (1-10) of 0.32 (SD 0.75) (n = 25)
and 0.88 (1.30) (n = 24), respectively. These ratings were significantly
lower than ratings after injection of a saline-Diprivan mixture (2.18
(2.06), n = 22). The pH of the 1% Diprivan formulation decreased after
mixing with 1% lignocaine. The concentration of propofol in the aqueous
phase was lower when 1% Diprivan was mixed with 1% lignocaine (0.376 g
litre-1) or HCl (0.392 g litre-1) compared with 1% Diprivan and saline
(0.476 g litre-1) mixed in the same proportion. Thus pH changes may modify
propofol-induced pain on injection by a mechanism different from the effect
of the local anaesthetic on the vascular endothelium. Our findings may
explain why lignocaine mixed with propofol causes less pain than injection
of lignocaine followed by propofol.
CLINICAL INVESTIGATIONS
Effect of lignocaine and pH on propofol-induced pain
Department of Anaesthesia and Intensive Care, University Hospital, S-751 85, Uppsala, Sweden; Department of Clinical Chemistry, University Hospital, S-751 85, Uppsala, Sweden; Hospital Pharmacy, University Hospital, S-751 85, Uppsala, Sweden
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