Pain During Injection of Propofol: The Effect of Prior Administration of Butorphanol

In Brief Propofol causes pain or discomfort on injection in 28%–90% of patients. A number of techniques have been tried for minimizing propofol-induced pain with variable results. We compared the efficacy of butorphanol and lidocaine for prevention of propofol-induced pain. One-hundred-fifty ASA I–II adults, undergoing elective surgery were randomly assigned into 3 groups of 50 each. GroupI(NS)receivednormalsaline,GroupII(L)received lidocaine 2% (40 mg), and Group III (B) received butorphanol 2 mg. All patients received pretreatment solutions made in 2 mL with normal saline administered over 5 s. One min after pretreatment patients received one-fourth of the total calculated dose of propofol (2.5 mg/kg) over 5 s. Assessment of pain with IV propofol was done by using a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain and 3 =severe pain at the time of propofol injection. In the control Group 39 (78%) patients had pain during propofol injection as compared to 21 (42%) and 10 (20%) in the lidocaine and butorphanol groups, respectively (P <0.05). Butorphanol was the most effective. We therefore suggest the IV pretreatment with butorphanol 2 mg for attenuation of pain associated with propofol injection. IMPLICATIONS: Pain associated with IV injection of propofol is seen in 28%–90% patients. Pretreatment with butorphanol 2 mg and lidocaine 40 mg attenuated the incidence and severity of pain associated with propofol injection. Butorphanol was the most effective and can be used routinely to prevent propofol pain.