Effect of intravenous injection of hydrocortisone and lidocaine 2% on pain after propofol injection: a double-blind randomized clinical trial

Authors
Mehrdad Melekshoar 1
Hashem Jarineshin 2
Majid Vatankhah 3
1 Assistant Professor of Anesthesiology, Intensive Care fellowship, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas.
2 Associated Professor of Anesthesiology, Cardiothoracic anesthesia fellowship, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas
3 Assistant Professor of Anesthesiology, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas
10.52547/jmj.17.3.43
Abstract
Introduction: Propofol is an intravenous anesthetic drug that has been widely used in outpatient and short-term
surgery due to its rapid recovery. However, pain during propofol injection can cause discomfort in 28 to 91% of patients. Various sources have argued that the effects of hydrocortisone and lidocaine on pain during propofol injection are contradictory. The present study was investigated the comparison of effect of hydrocortisone and lidocaine on pain during propofol injection.
Materials and Methods: In a randomized double-blind clinical trial, 150 patients, aged 15-65 years with ASA I and II physical grade who were candidates for elective surgery under general anesthesia at Shahid Mohammadi Hospital in Bandar Abbas in 2019 were enrolled. They were, randomly divided into 3 groups of 50 subjects'. Group a received lidocaine 2%, 1 mg / kg; group B received 25 mg hydrocortisone; and group C received 5 ml saline. The severity and incidence of pain after propofol injection were evaluated. Data were analyzed by SPSS software, version 19 and analyzed by independent t-test and chi-square or fisher exact test. P-values less than 0.05 were considered as significant.
Results: There was a significant difference in incidence of pain during propofol injection between the three groups (lidocaine and hydrocortisone, lidocaine and hydrocortisone with normal saline) (p<0.001). There was also a significant difference in pain severity between the lidocaine and hydrocortisone with normal saline groups, while there was no significant difference between the lidocaine and hydrocortisone groups (p= 0.615). The effect of hydrocortisone and lidocaine on pain was not significant. According to sex, age and weight
Conclusion: Hydrocortisone and lidocaine reduce pain during propofol injection and the effect of lidocaine was more
than hydrocortisone. However, using of these medications may be able to reduce the pain resulted during propofol injection.
Keywords
Lidocaine
Hydrocortisone
Pain intensity
Propofol
during2003;97:713–4. 3. Kwak K, Chung H, Lim C, Han C, Choi G, Lim D, et al. A combination of lidocaine (lignocaine) and remifentanil reduces pain during propofol injection. Clinical Drug Investigation 2007;27(7):493–7. 4. Brooker J, Hull CJ, Stafford M. Effect of lignocaine on pain caused by propofol injection. Anesthesia 1985;55:41–7. 5. Eriksson M, Englesson S, Niklasson F, Hartvig P. Effect of lignocaine and pH on propofol-induced pain. British Journal of Anaesthesia 1997;78(5):502–6. 6. Wong WH, Cheong KF. Role of tramadol in reducing pain on propofol injection. Singapore Medical Journal 2001;42: 193–5. 7. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ 2011;342:d1110. 8. Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesthesia and Analgesia 2000;90:963-9. 9. Derakhshan, P., Karbasy S.H., Bahador, R., 2015. The effects of nitroglycerine on pain control during the propofol injection; a controlled, double-blinded, randomized clinical trial. Anesth. Pain Med. 5 (3), e26141, http://dx.doi.org/10.5812/aapm.5(3)2015.26141., 10. Jeon, Y., 2012. Reduction of pain on injection of propofol: combination of nitroglycerin and lidocaine. J. Anesth. 26 (5), 728–731, http:// dx.doi.org/10.1007/s00540-012-1394-6. 11Picard, P., Trame` r, M.R., 2000. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth. Analg. 90 (4), 963–969. 12. Euasobhon, P., Dej-Arkom, S., Siriussawakul, A., Muangman, S., Sriraj, W., Pattanittum, P., Lumbiganon, P., 2016. Lidocaine for reducing propofol- induced pain on induction of anaesthesia in adults. Cochrane Database Syst. Rev. 18 (2), CD007874, http://dx.doi.org/10.1002/14651858. CD007874. 13. Ahmad, S., De Oliveira Jr., G.S., Fitzgerald, P.C., McCarthy, R.J., 2013. The effect of intravenous dexamethasone and lidocaine on propofol-induced vascular pain: a randomized double-blinded placebo-controlled trial. Pain Res. Treat. 734531, http://dx.doi.org/10.1155/ 2013/734531. 14. King SY, Davis FM, Wells JE, Murchison DJ, Pryor PJ. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg1992;74:246-9. 15. Scott RP, Saunders DA, Norman J. Propofol: Clinical strategies for preventing the pain of injection. Anaesthesia 1988;43:492-4. 16. Schimmer BP, Parker KL. Adrenocorticotropic hormone; Adrenocortical Steroids and their Synthetic Analogs; Inhibitors of the synthesis and actions of Adrenocortical hormones. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 11nd ed. New York: McGraw-Hill; 2006. p. 1599- 600. 17. Singh M, Mohta M, Sethi AK, Tyagi A. Efficacy of dexamethasone pretreatment for alleviation of propofol injection pain. Eur J Anaesthesiol 2005;22:888-90. 18. E. Kam,1 M. S. Abdul-Latif2 and A. McCluskey2 19. Jeong M, Yoon H. Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized, double-blind controlled trial. International Journal of Nursing Studies. 2016;100(61):209-18. 20. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesthesia & Analgesia. 1996 Mar 1;82(3):469-71. 21. Yadav M, Durga P, Gopinath R. Role of hydrocortisone in prevention of pain on propofol injection. J Anaesth Clin Pharmacol2011;27:470-4