This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fujii, Y. Search for Related Content PubMed PubMed Citation Articles by Fujii, Y.

Pretreatment with flurbiprofen axetil and venous occlusion to reduce pain during injection of propofol

Tsukuba, Japan

To the Editor:

One of the notable adverse effects of propofol is pain on injection.¹ The mechanism by which propofol causes pain on injection is unknown, but it has been attributed to release of a kininogen from the vein wall with triggering of a local kinin cascade.² A number of techniques have been tried to minimize propofol-induced pain, with variable results.³ This pain is reduced by ketorolac, a nonsteroidal anti-inflammatory drug (NSAID), with venous occlusion compared with ketorolac without venous occlusion.⁴ Flurbiprofen axetil (Ropion®, Kaken Seiyaku Co., Ltd., Tokyo, Japan) is classified as a NSAID, but unfortunately is not available in North America. This study was performed to test the hypothesis that pretreatment with flurbiprofen axetil and venous occlusion would reduce pain on propofol injection.

Forty women, aged 30 to 48 yr, and scheduled for uterocervical conization were enrolled. On arrival in the holding area of the operating room, a 20-gauge catheter was placed into the largest dorsal hand vein. Patients were randomly assigned to one of two groups, either flurbiprofen axetil 50 mg or placebo (n = 20 of each), with venous occlusion for two minutes, followed by the administration of propofol 0.5 mg•kg^–1. A researcher blinded to group assignment asked the patient to evaluate the pain (0 = none, 1 = mild, 2 = moderate, 3 = severe) during injection of propofol. Statistical analyses were performed by ANOVA and Chi-square test (with Yate’s continuity correction), as appropriate. P < 0.05 was considered significant. Values were mean ± SD or n (%). Patient demographics were not different between the groups. The incidence of pain was less in patients receiving flurbiprofen axetil (50%) than in those receiving placebo (85%; P < 0.05; Table).

References

1 Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005–43.[Medline]

2 Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia 1988; 43: 492–4.[Medline]

3 Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963–9.[Abstract/Free Full Text]

4 Yull DN, Barkshire KF, Dexter T. Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol. Anaesthesia 2000; 55: 284–7.[Medline]

5 Karasawa F, Ehata T, Okuda T, Satoh T. Propofol injection pain is not alleviated by pretreatment with flurbiprofen axetil, a prodrug of a nonsteroidal antiinflammatory drug. J Anesth 2000; 14: 135–7.[Medline]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Fujii, Y. Search for Related Content PubMed PubMed Citation Articles by Fujii, Y.