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Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified

[Un prétraitement veineux au sulfate de magnésium n’est pas justifié pour prévenir la douleur causée par l’injection de propofol]

Anil Agarwal, MD^*, Sanjay Dhiraj, MD^*, Mehdi Raza, MD^*, Ravinder Pandey, MD^*, Chandra Kant Pandey, MD^*, Prabhat K. Singh, MD^*, Uttam Singh, PhD and Devendra Gupta, MD^*

^* From the Departments of Anesthesia, and
Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Address correspondence to: Dr. Anil Agarwal, Department of Anesthesia, Type IV/48, SGPGIMS, Lucknow 226 014, India. Fax: +91-522-2668017; E-mail: aagarwal{at}sgpgi.ac.in

Purpose: Propofol produces anesthesia with rapid recovery. However, it causes pain or discomfort on injection. A number of techniques have been tried for minimizing propofol-induced pain with variable results. We have compared the efficacy of magnesium and lidocaine for the prevention of propofol induced pain.

Methods: Three hundred ASA I and II adults undergoing elective surgery were randomly assigned into three groups of 100 each. Group I received magnesium sulfate 1 g, Group II received lidocaine 2% (40 mg) and Group III received normal saline, all in a volume of 2 mL and accompanied by venous occlusion for one minute. Induction with propofol 2.5 mg•kg^-1 was accomplished following the release of venous occlusion. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of pretreatment and propofol injection. Results were analyzed by ‘Z’ test. A P value of < 0.05 was considered as significant.

Results: Pain during iv pretreatment with magnesium was 31% as compared to 2% for both the lidocaine and control groups (P < 0.05). Seventy-six percent of patients in the control group had pain during iv propofol as compared to 32% and 42% in the magnesium and the lidocaine groups respectively (P < 0.05). Lidocaine and magnesium pretreatment were equally effective in attenuating pain during the propofol injection (P > 0.05).

Conclusions: Intravenous magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain. However, magnesium pretreatment itself causes pain. Therefore, there is no justification in the use of magnesium pretreatment for attenuating pain associated with iv propofol.

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