Jul 17, 1997 - that of benzodiazepines when used for intravenous sedation. In addition, we eval- uated the efficacy ..... Malamed SF: Drug overdose reactions.
SCIENTIFIC REPORT
Pain Following Intravenous Administration of Sedative Agents: A Comparison of Propofol with Three Benzodiazepines Hideki Mamiya, Tomoko Noma, Kenichi Fukuda, Masataka Kasahara, Tatsuya Ichinohe, and Yuzuru Kaneko Department of Dental Anesthesiology, Tokyo Dental College, Chiba, Japan
The purpose of the present study is to compare the injection pain of propofol with that of benzodiazepines when used for intravenous sedation. In addition, we evaluated the efficacy of coadministering a small dose of 1% lidocaine (20 mg) to reduce the pain accompanying propofol injection. Intravenous propofol, diazepam, midazolam, or fiunitrazepam were administered on separate occasions to volunteers and outpatients. The degree of injection pain was evaluated by the Visual Analog Scale (VAS) ruler. The efficacy of premixed lidocaine with propofol was also compared among the patients. The venous pain of propofol was significantly more intense than that of the three other drugs (P < 0.05). The injection pain of diazepam was more intense than that of midazolam (P < 0.05). Many patients reported no pain when propofol was coadministered with lidocaine. The addition of a small dose (20 mg) of lidocaine reduced the VAS pain score to comparable levels observed for benzodiazepines. Because injection pain might affect the patients' comfort during sedation, the addition of lidocaine to the propofol injection is deemed useful for intravenous sedation.
Key Words: Pain; Propofol; Benzodiazepine; Visual Analog Scale.
I ntravenous sedation with propofol has been popular in recent years because of the characteristically quick and pleasant recovery of patients. However, intravenous propofol often causes severe vascular pain and discomfort on injection.' Similarly, some benzodiazepines are also known to cause injection pain in various degrees of intensities.2 We compared the injection pain of propofol with that of benzodiazepines when used for intravenous sedation in volunteers and in outpatients. In addition, we evaluated the efficacy of coadministering a small dose of lidocaine (20 mg) to reduce the pain accompanying propofol injection.
METHODS The studies were approved by our Medical Ethics Committee. All subjects gave their informed consent.
Study 1 Fourteen healthy male volunteers aged 23-29 yr were prospectively enrolled. They received intravenous propofol, diazepam, midazolam, or fiunitrazepam in a double-blind and cross-over protocol. The degree of injection pain was evaluated by the 100-mm Visual Analog Scale (VAS) ruler. Patients reported pain during injection as none, mild, moderate, or severe (almost intolerable) to a single observer who did not know which anesthetic was used. The evaluation was performed 30 sec after injection, when the volunteer remained conscious. Only one drug was administered on any day. All conditions,
Received July 17, 1997; accepted for publication January 26, 1998. Address correspondence to Hideki Mamiya, Department of Dental Anesthesiology, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba City, 261 Japan. Anesth Prog 45:18-21 1998 © 1998 by the American Dental Society of Anesthesiology
ISSN 0003-3006/98/$9.50 SSDI 0003-3006(98)
18
Anesth Prog 45:18-21 1998
Mamiya et al 19 Utah) inserted into a forearm vein and flushed with normal saline every 15 min. Diazepam (5 mg/ml) and propofol (10 mg/ml) were used as undiluted solutions, and 2 mg of flunitrazepam and 10 mg of midazolam were used as stock quantities diluted to 10 ml with distilled water. All agents used were approximately at room temperature. The speed of injection was standardized for diazepam at 2 mg in 30 sec and for both flunitrazepam and midazolam, 2 ml in 30 sec. The speed of injection for propofol was 0.5-1.0 ml/sec. The type of sedative used was randomized with respect to all volunteers and patients. The statistical significance of differences among the sedatives were tested by one-way analysis of variance (ANOVA) followed by a Scheffe test for the comparisons among the VAS scores. Probability values less than 5% were considered significant.
-. . P.u . .Dzepm
_ '...
I
...ean:SD
:* iC
