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An admixture of 3 mg·kg^-1 of propofol and 3 mg·kg^-1 of thiopentone reduces pain on injection in pediatric anesthesia

[Un mélange de 3 mg·kg^-1 de propofol et de 3 mg·kg^-1 de thiopental réduit la douleur à l’injection d’anesthésique chez les enfants]

Rachel C. Pollard, FRCA^*, Sonia Makky, FFA FRCSI^*, Jillian McFadzean, FRCA^*, Laurie Ainsworth, MSc, Susan M. Goobie, MD FRCPC^* and Carolyne J. Montgomery, MD FRCPC^*

^* From the Department of Anesthesia, and Clinical Research Support Unit,
British Columbia’s Children’s Hospital and the University of British Columbia, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Carolyne Montgomery, British Columbia’s Children’s Hospital, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada. Phone: 604-875-2711; Fax: 604-875-3221; E-mail: cmontgomery{at}cw.bc.ca

Purpose: To evaluate the incidence of pain on injection in children during anesthetic induction with a 3:1.2 volume admixture of 1% propofol and 2.5% thiopentone (P/T) compared to a 10:1 volume admixture of 1% propofol and 2% lidocaine (P/L).

Methods: After Ethics Committee approval and informed written parental consent, 127 children, aged one to ten years were studied and randomized into two groups; Group P/L received an induction with 5 mg•kg^-1 of 1% propofol and 1 mg•kg^-1 of lidocaine, Group P/T with 3 mg•kg^-1 of 1% propofol and 3 mg•kg^-1 of 2.5% thiopentone in a standardized fashion. A single, blinded observer scored pain behaviour defined as a motor response of the arm, a verbal complaint of pain, cry and/or one of three standardized facial expressions of pain.

Results: The incidence of pain was 14% in the P/T group, compared to 35% in the P/L group (²₁ = 7.5, P = 0.006). Motor response was the most frequent pain response in the P/L group (68%).

Conclusion: The P/T admixture is a practical and efficacious alternative to P/L for reducing pain on induction in children. Further work to evaluate the optimum proportions and possible adverse effects of this admixture should be done.

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				R. G. Cox Are children just little adults when it comes to propofol injection pain?/Les enfants ne sont-ils que de jeunes adultes face a la douleur caus'e par l'injection de propofol ? Can J Anesth, December 1, 2002; 49(10): 1016 - 1020. [Full Text] [PDF]