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Category: Volume 06 Issue 03 March 2018
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Title: Comparison of Ketamine Intravenous Infusion with Dexmedetomidine Intravenous Infusion to Alleviate Propofol Injection Pain

Authors: Dr Regimol V.Varghese

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.202

Abstract

Background and Aims: For induction of anaesthesia propofol is the most widely used intravenous anaesthetic agent. The induction of anaesthesia is rapid with propofol and also is recovery .But propofol injection pain (PIP) still remains a problem.  The incidence of pain on its injection is 28-90%. The high prevalence of pain makes it necessary to find an ideal drug or drug combination to alleviate the pain on propofol injection.

The aim of this study was to compare ketamine 0.5 mg/kg intravenous (IV) infusion with dexmedetomidine 0.5mcg/kg IV infusion to alleviate PIP.

Methods: In this prospective observational study 70 patients undergoing elective surgeries under general anaesthesia were randomly enrolled to two groups. 35 patients (group K) received ketamine 0.5 mg/kg IV and 35 patients (group D) received dexmedetomidine 0.5mcg/kg in 20ml normal saline over 10 minutes. Soon after the infusion, 1% propofol 2mg/kg IV was injected over 25 seconds. The pain was assessed by asking ‘does it hurt’ every 5 seconds, until the patient lost consciousness. McCririck and Hunter scale was used for pain scoring. Statistical analysis done-using-SPSS 22 version.

Results: 97.1% of patients in group K had no PIP where as 2.9% of group D had no PIP. In the dexmedetomidine group, 17.06% had severe pain, 37.12% had moderate pain. The incidence of PIP was significantly higher in group D compared to group K (P<0.05)

Conclusion: IV ketamine infusion is more effective than IV dexmedetomidine infusion to alleviate PIP.

Keywords: Ketamine, dexmedetomidine, propofol, anaesthesia, pain.

References

  1. Alex Macario, Matthew Weinger, P Truong, et al Which clinical anesthesia outcomes are both common and important to avoid. AnesthAnalg 1998;88:1085-91
  2. SimJy, Lee SH, Park DY, Jung JA, KiRH, Lee DH et al Pain or injection with microemulsionpropofol Br J clinpharmacol 2009;67:316-25
  3. King SY, Davis FM, Wells JE et al Lidocaine for the prevention of pain due to injection of propofolAnesthAnalg 1992;74:246-9
  4. Saadwy, Ertoke, Broker A Painless injection of propofol. Pretreatment with ketamine Vs TPS, meperidine and lidocaine Middle East J Anesthesiology 2007;19:631-44
  5. Visser E, SchngSA,. The role of ketamine in pain management. Biomed pharmacology 2006;60:341-8
  6. DeepaRavindraShriyan, BharkarMuralidharPatil. Evalution of low dose Ketamine pretreatment to reduce propofol injection pain. International journal of Anatomy, Radiology and Surgery 2016 DO1 : 10.7860/IJARS/2016/9523:2136
  7. Tan Ch, Onsong MK, Kna SW. The effect of Ketamine pretreatment on propofol injection. Anesthesia 1998; 53(3):302-6
  8. Uzuin S, Karagosse H, Kose E A et al Dexmed for prevention of propofol pain. J AnesthClinPharmacol 2008; 24:406-8
  9. Kamibayashi T, MageM, Clinical uses of µ2 adrenergic agonists. Aneasthesilogy 2000; 93:1345-9
  10. Callow ID, Campis P, Lampert MC et al. Enhanced in vivo µ1 and µ2 adrenoreceptor mediated venoconstriction with indomethacin in human. Am J physiol 1998;275:837-43
  11. Dale C, ShneiderM,Clerque F et al Inhibition of the current in isolated peripheral nerve; a novel mode of peripheral nociception.Muscle nerve 2001; 24:254-61.
  12. KoosW,Cho SJ, Kim YK, Ham K D ,Hwang JH Small dose ketamine reduces the pain  of propofol injection. Aneasthesilogy 2000; 103: 1444-7
  13. Jalota L, Kalira V, George E, Shiyy, Hornuas C, Radke O et al . Prevention of pain on injection of propofol. Systematic review and metaanalysis. BMJ 2011:342 D 1110
  14. Lee JH, Jung SY, Kim M H, Cho K. The effect of dexmedetomidine on propofol injection pain. Korean J Anesthesiol 2014:67suppl:S 30-1
  15. Picard P, Tramer M R. Prevention of pain an injection with propofol; A quantitative systematic review Anesth. Analg. 2000;90: 963 (a)
  16. Hwang J, Park HP, Lim Y J, Do sh, Lee SC, Jeon YT. Preventing pain on injection of propofol: a comparison between peripheral ketamine pretreatment and ketamine added to propofolAnesth Intensive care 2009;37:584-7
  17. SeemaThukral, Priyanka Gupta, ArchanaLakra, Mayank Gupta Dexmedetomidine versus ketamine infusion to alleviate propofol injection pain: A prospective rendominized and double Blind study; Indian J Anaesth 2015; 59: 488-92
  18. Sarkilar G, Kara I, Duman A, Okesli S. Effect of dexmedetomidine on pain caused by injection of propofol  Nobel Med.2012;8:83[8]

Corresponding Author

Dr Regimol V.Varghese

Assistant Professor, Department of Anesthesiology,

Government Medical College, Kottayam,

Kerala, India,

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