Degree of pain
in intravenous injection of propofol with intravenous lidocaine administration;
A Literature Review Study
Agung Manik Septiana
Putra1*, I Made Gede Widnyana2
Prima
Medika General Hospital, Denpasar, Bali, Indonesia1
Prima
Medika General Hospital, Denpasar, Bali, Indonesia 2
Email: [email protected]
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Abstrak |
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Injeksi propofol intravena
banyak digunakan untuk induksi anestesi dan sedasi, meskipun sering
menyebabkan ketidaknyamanan dan nyeri di tempat suntikan, yang menyebabkan
kecemasan pasien. Lidocaine, anestesi lokal, telah dipelajari kemampuannya
untuk mengurangi rasa sakit ini dengan menghambat saluran natrium, sehingga
mengurangi rangsangan neuron dan transmisi nyeri. Penelitian menunjukkan
bahwa lidokain intravena secara efektif mengurangi terjadinya dan intensitas
nyeri selama injeksi propofol. Penelitian ini bertujuan untuk menilai
efektivitas lidokain intravena dalam meminimalisir nyeri yang berhubungan
dengan injeksi propofol. Tinjauan pustaka dilakukan, menganalisis studi dari
tahun 2018 hingga 2024 yang diperoleh dari database seperti Google Scholar,
PubMed, dan ScienceDirect. Dua belas artikel yang memenuhi kriteria seleksi
ditinjau. Temuan ini secara konsisten menunjukkan bahwa lidokain intravena
secara signifikan menurunkan rasa sakit yang terkait dengan injeksi propofol.
Selain itu, penggunaan lidokain mengurangi dosis propofol yang diperlukan dan
meningkatkan kepuasan pasien. Studi menunjukkan bahwa pemberian lidokain
intravena sebelum atau selama injeksi propofol adalah pendekatan praktis
untuk mengurangi nyeri injeksi. Penelitian di masa depan harus fokus pada
pengoptimalan parameter yang meningkatkan efek analgesik lidokain, yang pada
akhirnya meningkatkan kenyamanan dan kepuasan pasien dalam prosedur yang
melibatkan sedasi. Kata kunci: Injeksi propofol, nyeri injeksi, lidokain
intravena, anestesi, analgesik. |
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Abstract Intravenous propofol
injection is widely used for anesthesia induction and sedation, though it
often causes discomfort and pain at the injection site, leading to patient
anxiety. Lidocaine, a local anesthetic, has been studied for its ability to
reduce this pain by inhibiting sodium channels, thereby decreasing neuronal
excitability and pain transmission. Research indicates that intravenous
lidocaine effectively reduces the occurrence and intensity of pain during
propofol injection. This study aims to assess the effectiveness of
intravenous lidocaine in minimizing pain related to propofol injection. A
literature review was conducted, analyzing studies from 2018 to 2024 obtained
from databases such as Google Scholar, PubMed, and ScienceDirect. Twelve
articles meeting the selection criteria were reviewed. The findings
consistently show that intravenous lidocaine significantly lowers the pain
associated with propofol injection. Additionally, lidocaine use reduced the
required propofol dosage and improved patient satisfaction. The studies
suggest that administering intravenous lidocaine before or during propofol
injection is a practical approach to reducing injection pain. Future research
should focus on optimizing the parameters that enhance lidocaine's analgesic
effects, ultimately improving patient comfort and satisfaction in procedures
involving sedation. Keywords: Propofol injection, injection pain,
intravenous lidocaine, anesthesia, analgesic |
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*Correspondence
Author: Agung Manik Septiana Putra
Email:
[email protected]
INTRODUCTION
Intravenous propofol injection is a commonly used method
as an anesthetic agent for induction and sedation due to its rapid onset and
short duration. However, one
of the significant
side effects of administering propofol is the
discomfort and pain experienced at the injection site, which can cause
anxiety in patients and hinder the desire to undergo further procedures.
Various studies have reported that pain during injections can be caused by
several factors, including the formulation of the drug, the speed of
administration, and the condition of the veins used (Ghimire &
Chand, 2021),(Bakhtiari et
al., 2021)
Lidocaine, which is a local anesthetic, has been researched as a preremediation to relieve pain associated
with propofol injections. The mechanism by which lidocaine exerts an
analgesic effect involves the
blockade of sodium channels, which reduces neuronal exitability and, consequently, the transmission of pain(Wasinwong et
al., 2022). Research shows
that administration of lidocaine prior to propofol injection significantly
reduces the incidence and intensity of pain associated with injection.
Several studies have shown the effectiveness of
intravenous lidocaine in reducing pain during propofol administration. Several randomized controlled trials showed a marked reduction in pain scores among patients receiving lidocaine
compared to those receiving propofol alone(Euasobhon et
al., 2016). In addition,
the timing and dosage of lidocaine administration have been explored, with
findings suggesting that both preemptive and co-administration of lidocaine
administration can be effective in reducing discomfort.
While these findings are promising, variations in
methodologies and patient populations across studies indicate the need for a
comprehensive review of the literature to determine optimal practices
in the concomitant use of lidocaine
in conjunction with propofol. Factors such as the patient's age, comorbidities,
and previous experience with anesthesia can also affect the level of pain
perceived, indicating the need for a tailored approach in pain management (Euasobhon et
al., 2016).
In conclusion, intravenous lidocaine administration
before or concurrently with propofol is a viable strategy for reducing
injection-related pain. Further research into the specific parameters
that maximize its analgesic effects
will contribute to improved patient
comfort and satisfaction during procedures
that require sedation with propofol. This literature review aimed to synthesize
the current evidence regarding the degree of pain associated with intravenous
propofol injection and the effectiveness of intravenous lidocaine as a
mitigating intervention.
RESEARCH
METHOD
The method used in this study is a literature review, which
is carried out to collect and analyze data related to the degree of pain in intravenous
propofol injection with intravenous lidocaine administration. This process
begins with searching for articles using academic search engines such as Google
Scholar, PubMed, and ScienceDirect. Keywords used in the search include
"Propofol injection pain," "Intravenous lidocaine,"
"Lidocaine for pain reduction," "Pain on intravenous propofol
administration," and "Analgesic effect of lidocaine."
Furthermore, articles that are eligible for inclusion in
this review must meet several selection criteria, such as publication in the
period of 2018 to 2024 to ensure the relevance and up-to-date of information.
In addition, the article discussed must examine the effect of lidocaine on pain
due to propofol injection, both in the context of clinical studies, randomized
trials, and meta-analysis, and written in English or Indonesian.
The screening process is carried out by analyzing the
abstract of the articles found, where only relevant and quality articles will
be included in this review. From the initial search, as many as 12 selected
articles that met the eligibility criteria were analyzed in depth. This
analysis includes research methods, results, and conclusions drawn from each
article to identify research patterns, findings, and contributions to the topic
being studied.
Data from the selected articles will be summarized and
synthesized to present comprehensive information on the effectiveness of
lidocaine in reducing pain due to propofol injections. These findings will be
organized in relevant themes, which are expected to provide a clear and
in-depth picture of the effectiveness of lidocaine, as well as contribute to
the development of clinical practice in the field of anesthesia.
RESULT
AND DISCUSSION
Table 1 presents a summary of studies related to the
effectiveness of lidocaine in reducing propofol injection pain in patients
undergoing various medical procedures. The study included a variety of
methodologies, including randomized controlled trials, that showed significant
results in pain management and reduction in the need for propofol doses. This
table aims to provide a comprehensive overview of the role of lidocaine in the
practice of anesthesiology. The full results are presented as follows:
Table 1. Study Related to Propofol Injection Pain
and Lidocaine Use
|
No. |
Heading |
Writer |
Year |
Methodology |
Key Results |
|
1 |
Comparison
between Nalbuphine Intravenosa and Lidocaine in
Reducing Propofol Injection Pain During Gastroscopy: A Randomized Controlled
Trial |
Wang et al.(Wang et al., 2020) |
2020 |
A
double-blind randomized controlled trial with 330 patients divided into three
groups: nalbuphine, lidocaine, and control. |
Nalbuphine
and lidocaine significantly reduced propofol injection pain compared to the
control group. Patients in the control group experienced higher levels of
pain and needed more propofol. |
|
2 |
Lidocaine
in Pain Prevention in Propofol Anesthesia Induction: A Randomized
Double-Controlled Clinical Trial |
Buffon
et al.(Luiza et al., 2020) |
2020 |
A
double-controlled randomized clinical trial on 970 adult subjects who
received propofol for induction of anesthesia. |
Lidocaine
reduces propofol injection pain (5% vs 14.2% in saline), but the NNT (10.9)
is quite high, so its use needs to be considered. |
|
3 |
Intravenous
Lidocaine Significantly Reduces the Propofol Dose in Elderly Patients
Undergoing Gastroscopy |
Hu
et al.(Hu et al., 2022) |
2022 |
A
prospective, single-center, double-blind randomized controlled clinical trial
in patients aged ≥65 years with ASA I-II. The patients were divided
into two groups: the lidocaine group (n=70) and the saline group (n=70). |
Lidocaine
IV reduced total dose and maintenance of propofol (p<0.001), as well as
reduced the incidence of intraoperative hypoxia (p=0.035), emergency airway
management (p<0.005), duration of gastroscopy (p<0.05), time to
re-consciousness (p0.001), and postoperative pain (p=0.009). Patient
satisfaction (p=0.025) and gastroscopic (p=0.031) were higher in the
lidocaine group. Hemodynamic parameters, respiration rate, sedation-related
events, and anesthesiologist satisfaction showed no difference between the two
groups. |
|
4 |
Effect
of Intraoperative Lidocaine Infusion on Postoperative Pain and Quality of
Recovery in Patients Undergoing Gynaecological
Laparoscopic Surgery |
Awal
et al.(Awal et al., 2022) |
2022 |
A
randomized controlled study involving 50 female patients aged 18�55 years who
underwent gynecological laparoscopic surgery, was divided into two groups
(lidocaine vs. saline). |
The
group that received lidocaine showed significantly higher quality of recovery
(QoR-40 score), faster recovery time, and a reduction in pain, nausea, and
analgesic use. |
|
5 |
Effect
of Ondansetron Compared to Lidocaine and Placebo in Reducing Pain of Propofol
Injection: A Randomized Clinical Trial |
Zaazouee et al.(Zaazouee et al., 2023) |
2022 |
A
meta-analysis of 23 RCTs involving 2957 participants, with searches through
PubMed, Embase, Cochrane Library, Web of Science, and Scopus up to May 2022. |
Ondansetron
increased postoperative discomfort rates compared to placebo (RR = 2.36) and
reduced moderate (RR = 0.39) and severe (RR = 0.34) pain. However, lidocaine
is more effective than ondansetron. |
|
6 |
Comparison
of Ondansetron and Lidocaine in Reducing Propofol Injection Pain: A
Randomized Controlled Study |
Wirat
Wasinwong et al.(Wasinwong et al., 2022) |
2022 |
The
study involved 240 patients with ASA I-III classification, aged 18-65 years,
undergoing elective surgery. Patients were divided into three groups: O
(ondansetron 8 mg), L (lidocaine 40 mg), and C (placebo). |
Group
L (lidocaine) showed the lowest incidence of pain (66.2%) compared to groups
O (82.5%) and C (85.0%) (P < 0.01). The median pain scores of groups L, O,
and C were 2, 4, and 4.5 (P < 0.01). |
|
7 |
Intravenous
Lidocaine Reduces Propofol Injection Pain through Local Anesthetic and
Central Analgesic Effects |
Jibin
Xing et al.(Xing et al., 2018) |
2018 |
The
randomized controlled study involved 1095 patients divided into groups |
A
dose of 40 mg of lidocaine is effective in reducing the pain of propofol
injection. Lidocaine reduces pain through local anesthetic effects and
central analgesic effects when the dose reaches 1.5 mg/kg. |
|
8 |
Lidocaine
for the prevention of pain caused by propofol injections: A controlled,
randomized, and double-blind study |
Sedat
Kaya et al.(Kaya et al., 2022) |
2022 |
Randomized
controlled study, involving 100 women aged 18-45 years, divided into 5 groups |
The
use of lidocaine 20 mg with or without venous occlusion significantly reduced
the incidence and intensity of pain during propofol injection compared to the
control group. Vein occlusion for 60 seconds is most effective. |
|
9 |
Efficacy
and safety of additional intravenous lidocaine for sedation in
gastrointestinal endoscopic procedures: a systematic review and meta-analysis
of randomized controlled trials |
Faisal
Kamal et al.(Kamal et al., 2021) |
2021 |
A
systematic review and meta-analysis of 5 randomised
controlled trials with 318 patients, comparing lidocaine and propofol with
propofol alone. |
Lidocaine
significantly reduced the required dose of propofol (SMD, -0.76; 95% CI,
-1.09 to -0.42). There was no significant difference in the timing of the
procedure or adverse events between the two groups. |
|
10 |
Intravenous
Lidocaine Infusion for Initial Postoperative Pain Management: A Comprehensive
Review of the Controlled Trial |
Robert
Chu et al.(Chu et al., 2020) |
2020 |
A
review of randomized controlled trials to summarize the pharmacokinetic,
antinociceptive, anti-hyperalgesic,
anti-inflammatory, and side effects of lidocaine. |
Intravenous
infusion lidocaine is safe and effective in managing initial postoperative
pain, with a loading dose of 1�2 mg/kg and a continuous infusion of 1�2
mg/kg/hour. Common side effects include hypotension, headache, and nausea.
Serious effects include heart block and arrhythmias. |
|
11 |
Lidocaine
for reducing propofol-induced pain in induction of anesthesia in adults |
Pramote Euasobhon
et al.(Euasobhon et al., 2016) |
2016 |
A
systematic review of randomised controlled trials
(RCTs) comparing lidocaine with placebo in reducing pain with propofol
injection. It includes searching for data from various databases and
meta-analysis using the Mantel-Haenszel method. |
Lidocaine
is effective in reducing pain after propofol injection; with a pain rate of
64% in the control group and 30.2% in the lidocaine group. Lidocaine
admixture and pretreatment showed a significant reduction in pain with odds
ratios (OR) of 0.19 and 0.13, respectively. Side effects are rare. |
|
12 |
Can
intravenous lidocaine definitively reduce the need for propofol and improve
outcomes in colonoscopy patients using intravenous sedation? |
Nongnuang et al.(Nongnuang et al., 2022) |
2022 |
A
randomized, double-blinded controlled trial on 68 colonoscopy patients, with Bispectral Index (BIS) monitoring. |
Intravenous
lidocaine significantly reduced total propofol use (151.76 mg vs 242.06 mg, P
<.001) and improved patient satisfaction as well as the duration of BIS
recovery > 85 without side effects. |
Table 1 shows the results of studies on the use of lidocaine
to reduce propofol injection pain, which is widely seen as an effective
intervention in anesthesiology practice. Most studies confirm that lidocaine,
whether administered intravenously or via infusion, is significant in reducing
pain levels when injecting propofol, with studies noting a significant
reduction in pain compared to the control group, highlighting the effectiveness
of lidocaine in this context (Wang et al., 2020),(Hu et al., 2022).
Further, several studies compared lidocaine with other
drugs, such as ondansetron and nalbuphine, and found that lidocaine was
superior in terms of pain reduction (Wasinwong et al., 2022),(Zaazouee et al., 2023). This provides
support for the use of lidocaine as the primary option in pain management of
propofol injections. In addition, the importance of proper dosage to achieve
the desired results without adverse side effects was also emphasized in the
study (Kamal et al., 2021),(Chu et al., 2020), which
suggests that the use of lidocaine may reduce the total dose of propofol
required.
The studies also show that lidocaine is not only effective
in reducing injection pain but also contributes to faster postoperative
recovery, as reported in the context of gynecological laparoscopic surgery (Awal et al., 2022). Thus, the use
of lidocaine in anesthesiology practice provides a dual benefit: it reduces
pain during propofol injections and improves the overall patient experience.
Discussion
The use of intravenous lidocaine as a pain-relieving agent
during propofol injection is an increasingly accepted approach in the practice
of anesthesia. Lidocaine, known as a local anesthetic, has a mechanism of
action focused on inhibiting sodium channels, which serves to block the
transmission of pain signals by preventing depolarization of neuronal membranes(Herminghaus et al., 2021),(Yang et al., 2020). Thus, the use
of lidocaine before or during propofol injections can reduce the pain arising
from the procedure.
In the context of propofol, lidocaine not only serves to
reduce discomfort, but it can also reduce the dose of propofol required to
achieve the desired level of sedation. Research shows that by using lidocaine,
patients are likely to require lower doses of propofol, which means reduced
risks associated with propofol use, such as respiratory depression and
decreased consciousness(Forster et al., 2018),(Jalota et al., 2021). This is
especially important because propofol has a side effect profile that can be
dangerous if not closely monitored.
Furthermore, the use of lidocaine in anesthesia practices
can also contribute to faster patient recovery. Some studies show that patients
who receive lidocaine experience lower pain levels and have shorter recovery
times, as well as experience fewer postoperative complications(Lee & Schraag, 2022),(Joppich, 2022). This decrease
in pain is directly related to increased patient satisfaction with their
anesthesia experience.
Based on these evidences, it can be concluded that
intravenous lidocaine offers significant benefits in managing pain during
propofol injection, while improving anesthesia efficiency and overall patient
satisfaction. Therefore, further research is needed to determine the optimal
dosage protocol and explore the clinical applications of lidocaine beyond the
use of propofol injection.
CONCLUSION
Lidocaine has been shown to be effective in reducing
propofol injection pain in patients undergoing medical procedures. The use of
lidocaine, either intravenously or intravenously, can significantly lower pain levels
and reduce the total dose of propofol required. Therefore, lidocaine should be
considered as the primary choice in pain management of propofol injections,
with attention paid to the right dosage to minimize side effects. Further
research is needed to determine the optimal and safe dosage and method of
application of lidocaine.
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