Abstract
Purpose
Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain.
Methods
After institutional review board (IRB) approval and informed consent, we performed a prospective, double-blind, placebo-controlled, randomized trial. Subjects were randomly assigned to pretreatment with either lidocaine (50 mg), magnesium sulfate (0.25 mg), lidocaine (50 mg) plus magnesium sulfate (0.25 mg), or 0.9 % sodium chloride. Following pretreatment, propofol (50 mg) was administered, and subjects were questioned regarding injection site pain and observed for behavioral signs of pain.
Results
Two hundred subjects were enrolled and 158 subjects (39 placebo, 38 lidocaine, 44 magnesium sulfate, and 37 lidocaine plus magnesium sulfate) received their assigned pretreatment intervention. Intergroup baseline characteristics were similar. The proportion of subjects reporting propofol injection pain was highest in those pretreated with magnesium sulfate (57 %), followed by those pretreated with placebo (46 %), lidocaine plus magnesium sulfate (41 %), and then lidocaine (29 %; p = 0.011). When adjusted for age, gender, diabetes mellitus, chronic pain, tobacco use, and selective-serotonin reuptake inhibitor use, the pain response scale scores were significantly reduced by lidocaine pretreatment compared to magnesium sulfate and placebo (p = 0.031 and p = 0.0003, respectively).
Conclusions
In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.
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Acknowledgments
This study was supported by (1) intradepartmental funding from the Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, and (2) a National Institutes of Health, National Center for Advancing Translational Sciences, Clinical Translational Science Award Program grant, UL1TR000427. The authors have no commercial or non-commercial affiliations that are or may be perceived to be a conflict of interest. The authors would like to thank Luke Hattenhauer, CRNA, MS APNP, James Albrecht, CRNA, MS APNP, Peter Shearer, MMSc, AA-C, Guangde Chen, MS, and Brooke Anderson, RN, MSN, for their assistance with initiating, conducting, and evaluating this clinical trial.
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Prior Presentation American Society of Anesthesiologists 2012 Annual Meeting, Washington, DC.
Trial registration www.ClinicalTrials.gov (Identifier: NCT 01342510; URL: http://www.clinicaltrials.gov/ct2/show/NCT01342510?term=01342510&rank=1).
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Galgon, R.E., Strube, P., Heier, J. et al. Magnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial. J Anesth 29, 206–211 (2015). https://doi.org/10.1007/s00540-014-1892-9
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DOI: https://doi.org/10.1007/s00540-014-1892-9