Published: 2019-02-23

A randomized controlled trial to compare effects of different volume and concentration of lidocaine for preventing propofol injection pain in adults

Ashish Patyal, Anjana Verma, Madhavi Buddhi


Background: Pain on propofol injection is an unwanted effect which can lead to decreased patient satisfaction. Although many studies have shown that pre-treatment with lidocaine injection is effective in this pain, nevertheless, very few studies have been done  on different concentration and volume of lidocaine, effective of reducing pain significantly. Objective of the current study was to assess and compare the efficacy of intravenous lidocaine with  0.4% and 2% concentration in reducing the incidence and severity of propofol injection pain.

Methods: A total of 126 American Society of Anesthesiologist grade I and II patients with age ≥18 years, scheduled for an elective surgery, were enrolled in the study. Patients were randomized into two equal groups of 63 each. Group A (n = 63) received pretreatment with 0.4% lidocaine and group B (n = 63) received 2% lidocaine. Propofol injection pain was measured by using Numeric Rating Scale (NRS) and Withdrawl Response Scale (WRS). Unpaired t test, ANOVA and Chi square test were used for statistical analysis.

Results: A statistically significant decrease in the pain was recorded in group A (0.4% lidocaine) as compared to group B (2% lidocaine). Using NRS scale, 12% of patients in group A as compared to 33% patients of group B, experienced pain (p =0.02); while using WRS, 8% patients of group A as compared to 27% group B patients experienced pain (p= 0.04).

Conclusions: The pain on injection of propofol is significantly decreased by the use of 0.4% lidocaine in comparison with 2% Lidocaine.


Adults, Injection pain, India, Lidocaine, Propofol, Randomized controlled trial

Full Text:



Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in anaesthesia and conscious sedation. Drugs. 1995;50:513-59.

Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg. 1999;88:1085‑91.

Briggs LP, Clarke RS, Dundee JW, Moore J, Bahar M, Wright PJ. Use of di‑isopropyl phenol as main agent for short procedures. Br J Anaesth. 1981;53:1197‑202.

Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia.1998;53:468‑76.

Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: a randomized, controlled, double-blinded study. Anesth Analg. 1999 Jul 1;89(1):197-9.

Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: A comparison of lidocaine with alfentanil. Anesth Analg. 1996;82:469-71.

Brooker J, Hull CJ, Stafford M. Effect of lignocaine on pain caused by propofol injection. Anaesth. 1985 Jan;40(1):91-2.

McCrirrick A, Hunter S. Pain on injection of propofol: the effect of injectate temperature. Anaesth. 1990 Jun;45(6):443-4.

Madenoglu H, Akin A, Dogru K, Boyaci A. Ketamine for the prevention of pain due to injection of propofol. Erciyes Med J. 1996;18:146-9.

Borazan H, Sahin O, Kececioglu A, Uluer MS, Et T, Otelcioglu S. Prevention of propofol injection pain in children: A comparison of pretreatment with tramadol and propofol-lidocaine mixture. Int J Med Sci. 2012;9(6):492.

Canbay O, Celebi N, Arun O, Karagöz AH, Sarıcaoğlu F, Özgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth. 2007 Oct 23;100(1):95-8.

Memiş D, Turan A, Karamanlioğlu B, Kaya G, Pamukçu Z. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesthesiol. 2002 Jan;19(1):47-51.

Zahedi HA, Nikooseresht MA, Seifrabie MO. Prevention of propofol injection pain with small-dose ketamine. Middle East J Anesthesiol. 2009 Oct;20(3):401.

Dubey PK, Kumar A. Pain on injection of lipid-free propofol and propofol emulsion containing medium-chain triglyceride: a comparative study. Anesth Analg. 2005 Oct 1;101(4):1060-2.

Euasobhon P, Dej‐arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, Lumbiganon P. Lidocaine for reducing propofol‐induced pain on induction of anaesthesia in adults. Cochrane Database Sys Rev. 2016(2).

Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000 Apr 1;90(4):963-9.

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 Mar 15;342:d1110.

Gharavi M, Sabzevari A, Ghorbanian E, Sajadi R, Akhondi M. Effect of Lidocaine Volume and Concentration on Preventing Incidence and Severity of Propofol Injection Pain. Iranian Red Crescent Med J.2014;16(3).

Ayoglu H, Altunkaya H, Ozer Y, Yapakci O, Cukdar G, Ozkocak I. Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? Eur J Anaesthesiol. 2007;24:541-5.

Hwang I, Noh JI, Kim SI, Kim MG, Park SY, Kim SH, et al. Prevention of pain with the injection of microemulsion propofol: a comparison of a combination of lidocaine and ketamine with lidocaine or ketamine alone. Korean J Anesthesiol. 2010;59:233-7.

Choi YJ, Park HS, Lee H, Yoon SZ. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol. 2012 Nov 1;63(5):413-8.

Shabana AM. Prevention of propofol injection pain, using lidocaine in a large volume does it make a difference? A prospective randomized controlled double blinded study. Egyptian J Anaesth. 2013 Oct 1;29(4):291-4.