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Summary In a randomised, double-blinded, two-centre trial we evaluated the effect of a microbiological filter (Supor®, Pall Life Sciences) on propofol injection pain. We studied 336 unpremedicated adult patients, who graded pain experienced during induction of anaesthesia with propofol on a 4-point verbal rating scale. Use of the microfilter reduced both the incidence and severity of propofol injection pain (p

A randomised, controlled, single-blind study was performed on 100 patients to investigate a new method of reducing pain on propofol injection. Aspiration of 2 ml of the patient's blood into a syringe of propofol immediately before injection was compared with the addition of lignocaine 20 mg or normal saline 2 ml to the propofol before injection. The addition of blood was significantly more effective in reducing pain on injection than the addition of saline (p < 0.001), but was not significantly more effective than the addition of lignocaine.

Pain on injection of propofol is a common problem, the cause of which remains unknown. The chemical properties and preparation of propofol, proposed mechanisms for the cause of the pain and clinical strategies to prevent pain on injection of propofol are reviewed in the hope of shedding some light on the subject.

A controlled, randomised double-blind study was performed to compare the prior intravenous administration of ketamine 10 mg (1 ml) or 0.9% saline (1 ml) on propofol injection pain. One hundred patients of ASA status 1 or 2 presenting for gynaecological surgery were studied. Following an initial 5-ml bolus of propofol into a dorsal hand vein, 30 s after the treatment, 84% of the saline control patients experienced mild or severe pain compared to 26% of those who were given ketamine pretreatment (p < 0.05).

A single-blind, randomised, controlled study was undertaken to compare the efficacy of three methods of preventing pain during injection of propofol on induction of anaesthesia. Patients were allocated randomly to receive unmodified propofol, propofol with 0.05% lignocaine, propofol at 4 degrees C and unmodified propofol preceded by 10 ml of 0.9% saline at 4 degrees C. Prior injection of cold saline reduced the incidence of pain and discomfort significantly (22%) compared with unmodified propofol (75%; p less than 0.005) and was similar to that after cold propofol (33%) and propofol with lignocaine (44%). There was no significant difference between the treatment groups.

Summary Assessment of pain on injection of the emulsified formulation of di-isopropylphenol (propofol, ‘Diprivan’) was undertaken in 120 unpremedicated patients and comparison made with thiopentone. A high incidence of pain (37.5%) was found using dorsal hand veins, but use of forearm veins showed only a 2.5% incidence of pain. The use of intravenous lignocaine immediately before propofol injection only partially reduced the incidence of pain using dorsal hand veins (17.5%). A degree of cardiorespiratory depression accompanied induction but the incidence of other side effects was low.