Title: A Prospective Evaluative Study between Low Dose Ketamine and Fentanyl as Pre Medication for Alleviation of Propofol Injection Pain
Authors: Mohamad Ommid, Saba Ahad, Shazada Gani , Faisal Rasool Dar, Mushtaq Rather, Humera Manzoor
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.88
Abstract
Purpose: To evaluate the pain on injection of propofol via pretreatment with low dose of ketamine and low dose of Fentanyl in patients undergoing elective surgery under general anaesthesia.
Methods: Total 60 patients were randomly allocated into two groups 6 groups. Group K (Ketamine Group): Received ketamine 0.15 mg/kg iv, 1 minute before injection of propofol and Group F (Fentanyl Group): Received Fentanyl 1.5mcg/kg iv, 1 minute before injection of propofol. All patients were monitored for the blood pressure (MAP), heart rate (HR), and oxygen saturation (SpO2). Additionally, the pain intensity was assessed using a 4-point verbal rating scale (VRS) by professional doctors.
Results: The incidence of pain due to propofol injection in Group K 22 (62.85%) of the patients did not represent any pain and in Group F 24 (68.27%) of the patients does not show any pain during propofol injection. However, the difference between the two groups was statistically insignificant with p value of 0.782.
Conclusion: From the findings of our study, it may be concluded that pre-treatment with low dose intravenous ketamine 0.15mg/kg and intravenous Fentanyl 1.5mcg/kg with a tourniquet just before propofol injection, significantly reduced the incidence and degree of propofol induced pain without significant adverse hemodynamic effects.
Keywords: General surgery, Propofol. Fentanyl. Ketamine, pain.
References
- Marik PE; Propofol: therapeutic indications and side-effects. Curr Pharm Des2004;10:3639-49
- Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Apfel CC; Prevention of pain on injection of propofol: systematic review and metaanalysis. Bmj, 2011; 342.
- Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia. 1998 May; 53(5):468-76.
- Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. Smalldose ketamine reduces the pain of propofol injection. AnesthAnalg. 2006 Dec;103(6):1444-7
- Ray S, Pal R, Pal S,Kirtania J, Sarbapalli D, Sarkar U et al. Preclusion of pain on injection with propofol: Evaluating the effects of lignocaine or Fentanyl pretreatment. Anesthesia, Essays and Researches.2011;5(1):33-38.
- Euliano TY, Gravenstein JS (2004). A brief pharmacology related to anesthesia". Essential anesthesia: from science to practice. Cambridge, UK: Cambridge University Press. p. 173. ISBN 0-521-53600-6. Retrieved 2009-06-02.
- "Drugs@FDA: FDA Approved Drug Products". Accessdata.fda.gov. Retrieved 2013-06-08.
- RAU J, ROIZEN MF, DOENICKE AW, ET AL: Propofol in an emulsion of long-and medium-chain triglycerides: the effect on pain. Anesth Analg; 93:382-4, 2001.
- SKLAR GE: Propofol and postoperative infections. Ann Pharmacother; 31:1521-3, 1997.
- FLETHCHER JE, SEAVELL CR, BOWEN DJ: Pre-treatment with alfentanil reduces pain caused by propofol. Br J Anaesth; 72:342-4, 1994. Saadawy I, Ertok E, Boker A. Painless injection of propofol: pretreatment with ketamine vs thiopental, meperidine, and lidocaine. Middle East J Anaesthesiol. 2007 Oct;19(3):631-44
- Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. Smalldose ketamine reduces the pain of propofol injection. Anesth Analg. 2006 Dec;103(6):1444-7.
- Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia. 1998 Mar;53(3):302-5.
- 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.
- Kang H-J, Kwon M-Y, Choi B-M, Koo M-S, Jang Y-J, Lee M-A. Clinical factors affecting the pain on injection of propofol. Korean J Anesthesiol 2010 Mar; 58(3): 239-243.
- Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women.
- Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg.2006 Dec;103(6):1444-7.
- 1998 Mar;53(3):302-5 Pang WW, Mok MS, Huang S, Hwang MH. The analgesic effect of fentanyl, morphine, meperidine, and lidocaine in the peripheral veins: A comparative study.AnesthAnalg. 1998;86:382–6
- Kang H-J, Kwon M-Y, Choi B-M, Koo M-S, Jang Y-J, Lee M-A. Clinical factors affecting the pain on injection of propofol. Korean J Anesthesiol 2010 Mar; 58(3): 239-243.