Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.12.001
Brazilian Journal of Anesthesiology
Scientific Article

Use of remifentanil to reduce propofol injection pain and the required propofol dose in upper digestive tract endoscopy diagnostic tests

Uso do remifentanil para redução da dor à injeção de propofol e a dose necessária de propofol em exames de endoscopia digestória alta diagnóstica

Gustavo Nadal Uliana; Elizabeth Milla Tambara; Giorgio Alfredo Pedroso Baretta

http://dx.doi.org/10.1016/j.bjane.2014.12.001 Braz J Anesthesiol, vol.65, n6, p.437-444, 2015
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Abstract

BACKGROUND AND OBJECTIVES: The introduction of propofol (2,6-diisopropylphenol) as a sedative agent has transformed the area of sedation for endoscopic procedures. However, a major drawback of sedation with the use of propofol is its high incidence of injection pain. The most widely used technique in reducing propofol injection pain is through the association of other drugs. The aim of this study was to evaluate the effect of remifentanil-propofol combination on the incidence of propofol injection pain and its influence on the total dose of propofol required for sedation in upper digestive tract endoscopy (UDE) diagnostic tests. METHOD: One hundred and five patients undergoing upper digestive tract endoscopy were evaluated and randomly divided into 3 groups of 35 patients each. The Control Group received propofol alone; Study-group 1 received remifentanil at a fixed dose of 0.2 mg/kg combined with propofol; Study-group 2 received remifentanil at a fixed dose of 0.3 mg/kg combined with propofol. The incidence of propofol injection pain and the total dose of propofol required for the test were evaluated. The sample was very similar regarding age, weight, height, sex, and physical status. Statistical analysis was performed according to the nature of the evaluated data. Student'st-test was used to compare the mean of age, weight, height (cm), and dose (mg/kg) variables between groups. The χ2 test was used to compare sex, physical status, and propofol injection pain between groups. The significance level was a < 0.05. RESULTS: There was significant statistical difference between the study groups and the control group regarding the parameters of propofol injection pain and total dose of propofol (mg/kg) used. However, there were no statistical differences between the two study groups for these parameters. CONCLUSION: We conclude that the use of remifentanil at doses of 0.2 mg/kg and 0.3 mg/kg was effective for reducing both the propofol injection pain and the total dose of propofol used.

Keywords

Sedation, Upper GI diagnostic test, Propofol, Remifentanil

Resumo

JUSTIFICATIVA E OBJETIVOS: A introdução do propofol (2,6-di-isopropilfenol) como agente sedativo tem transformado a área da sedação para procedimentos endoscópicos. Entretanto, um grande inconveniente da sedação com o uso do propofol é sua alta incidência de dor à injeção. A técnica mais usada na redução da dor à injeção do propofol tem sido a associação com outros fármacos. O objetivo deste estudo foi avaliar a repercussão da associação do remifentanil com o propofol na incidência de dor à injeção de propofol e a influência na dose total de propofol necessária para sedação em endoscopia digestória alta (EDA) diagnóstica. MÉTODO: Foram avaliados 105 pacientes, submetidos à EDA diagnóstica e divididos aleatoriamente em três grupos de 35. O Grupo Controle foi sedado apenas com propofol. O Grupo de Estudo 1 foi sedado com remifentanil em dose fixa de 0,2 µg/kg associado ao propofol. E o Grupo de Estudo 2 foi sedado com remifentanil em dose fixa de 0,3 µg/kg associado ao propofol. Foram avaliadas a incidência de dor à injeção de propofol e a dose de propofol necessária para o exame. A amostra se mostrou bastante similar em relação às variáveis idade, peso, altura, sexo e estado físico. De acordo com a natureza dos dados estudados, procedeu-se ao tratamento estatístico julgado adequado. Usou-se o teste t para comparação, entre os grupos analisados, das médias das variáveis idade, peso, altura (cm) e dose (mg/kg). Foi usado o teste ?2 para comparação, entre os grupos analisados, das variáveis sexo, estado físico e dor à injeção de propofol. O nível de significância adotado foi a < 0,05. RESULTADO: Houve diferença estatística significativa entre os grupos de estudo e o grupo controle tanto no parâmetro dor à injeção de propofol quanto no parâmetro dose de propofol usada (mg/kg). Entretanto, não houve diferenças estatísticas entre os dois grupos de estudo para esses parâmetros. CONCLUSÃO: O uso do remifentanil nas doses de 0,2 µg/kg e de 0,3 µg/kg mostrou-se efetivo tanto sobre o parâmetro redução da dor à injeção de propofol quanto sobre o parâmetro dose de propofol usada.

Palavras-chave

Sedação, Endoscopia digestória alta diagnóstica, Propofol, Remifentanil

References

Pambianco DJ, Vargo JJ, Pruitt RE. Computer-assisted personalized sedation for upper endoscopy and colonoscopy: a comparative, multicenter randomized study. Gastrointest Endosc.. 2011;73:765-72.

Cohen LB, Wecsler JS, Gaetano JN. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol.. 2006;101:967-74.

Lewis JR, Cohen LB. Update on colonoscopy preparation, pre- medication, and sedation. Expert Rev Gastroenterol Hepatol.. 2013;7:77-87.

Diprivan (propofol) injectable emulsion [package insert]. 2005.

King SY, Davis FM, Wells JE. Lidocaine for the prevention of pain due to injection of propofol. Anesth Analg.. 1992;74:246-9.

Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg.. 2000;90:963-9.

Stark RD, Binks SM, Dutka VN. A review of the safety and tolerance of propofol (Diprivan). Postgrad Med J.. 1985;61 Suppl 3:152-6.

Mangar D, Holak EJ. Tourniquet at 50 mmHg followed by intra- venous lidocaine diminishes hand pain associated with propofol injection. Anesth Analg.. 1992;74:250-2.

Macario A, Weinger M, Truong P. Which clinical anesthesia outcomes are both common and important to avoid? The per- spective of a panel of expert anesthesiologists. Anesth Analg.. 1999;88:1085-91.

Wallentine CB, Shimode N, Egan TD. Propofol in a modified cyclodextrin formulation: first human study of dose- response with emphasis on injection pain. Anesth Analg.. 2011;113:738-41.

Dye DWJ. Suspected anaphylactic reaction to Cremofor EL. Br Med J.. 1980;280:1353.

Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluents. Br J Anaesth.. 1991;67:281-4.

Von Dardel O, Mebius C, Mossberg T. Fat emulsion as a vehicle for diazepam. A study in 9,294 patients. Br J Anaesth.. 1983;55:41-7.

Gran L, Bleie H, Jeppson R. Etomidat mil intralipid. Eine losung zur schmerzfreien injection. Anaesthetist.. 1983;32:475-7.

Nyman Y, Von Hofsten K, Palm C. Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. Br J Anaesth.. 2006;97:536-9.

Shao X, Li H, White PF. Bisulfite-containing propofol: is it a cost-effective alternative to Diprivan for induction of anes- thesia?. Anesth Analg.. 2000;91:871-5.

Kunitz O, Losing R, Schulz-Stubner S. Propofol-LCT versus propofol-MCT/LCT with or without lidocaine: a compar- ison on pain on injection. Anasthesiol Intensivmed Notfallmed Schmerzther.. 2004;39:10-4.

Rohm KD, Piper SN, Schollhorn TA. Injection pain sec- ondary to propofol-MCT/LCT and propofol- LCT: comparison of prophylaxis with lidocaine. Anasthesiol Intensivmed Notfallmed Schmerzther.. 2003;38:643-7.

Larsen B, Beerhalter U, Biedler A. Less pain on injection by a new formulation of propofol: a comparison with propofol LCT. Anaesthesist.. 2001;50:842-5.

Dubey PK, Kumar A. Pain on injection of lipid-free propofol and propofol emulsion containing medium-chain triglyc- eride: a comparative study. Anesth Analg.. 2005;101:1060-2.

Larsen R, Beerhalter U, Erdkonig R. Injection pain from propofol-MCT-LCT in children: a comparison with propofol- LCT. Anaesthesist.. 2001;50:676-8.

Rochette A, Hocquet AF, Dadure C. Avoiding propo- fol injection pain in children: a prospective, randomized, double-blinded, placebo-controlled study. Br J Anaesth.. 2008;101:390-4.

O'Hara JF, Sprung J, Laseter JT. Effects of topical nitro- glycerin and intravenous lidocaine on propofol-induced pain on injection. Anesth Analg.. 1997;84:865-9.

Cheong MA, Kim KS, Choi WJ. Ephedrine reduces the pain from propofol injection. Anesth Analg.. 2002;95:1293-6.

Agarwal A, Ansari MF, Gupta D. Pretreatment with thiopen- tal for prevention of pain associated with propofol injection. Anesth Analg.. 2004;98:683-6.

Memis D, Turan A, Karamanlioglu B. The use of magnesium sulfate to prevent pain on injection of propofol. Anesth Analg.. 2002;95:606-8.

Koo SW, Cho SJ, Kim YK. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg.. 2006;103:1444-7.

Canbay O, Celebi N, Arun O. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth.. 2008;100:95-8.

Borazan H, Sahin O, Kececioglu A. Prevention of propo- fol injection pain in children: a comparison of pretreatment with tramadol and propofol-lidocaine mixture. Int J Med Sci.. 2012;9:492-7.

Aouad MT, Siddik-Sayyid SM, Al-Alami AA. Multimodal analgesia to prevent propofol-induced pain: pretreatment with remifentanil and lidocaine versus remifentanil or lidocaine alone. Anesth Analg.. 2007;104:1540-4.

Al- Refai AR, Al-Mujadi H, Ivanova MP. Prevention of pain on injection of propofol: a comparison of remifen- tanil with alfentanil in children. Minerva Anestesiol.. 2007;73:219-23.

Basaranoglu G, Erden V, Delatioglu H. Reduction of pain on injection of propofol: a comparison of fentanyl with remifen- tanil. Anesth Analg.. 2002;94:1040-1 [Letter].

Minto CF, Schnider TW, Short TG. Response sur- face model for anesthetic drug interactions. Anesthesiology.. 2000;92:1603-16.

Duarte NMC, Pires OC, Nunes CEL. Anestesia venosa total. 2011:73-82.

Hayes JA, Lopez AV, Pehora CM. Coadministration of propofol and remifentanil for lumbar puncture in children. Anesthesiology.. 2008;109:613-8.

Wang D, Chen C, Chen J. The use of propofol as a sedative agent in gastrointestinal endoscopy: a meta-analysis. PLOS ONE.. 2013;8:e53311.

Scott RP, Saunders DA, Norman J. Propofol: clinical strate- gies for preventing the pain of injection. Anaesthesia.. 1988;43:492-4.

Tan LH, Hwang NC. The effect of mixing lidocaine with propofol on the dose of propofol required for induction of anesthesia. Anesth Analg.. 2003;97:461-4.

Eriksson M, Englesson S, Horte I. The anaesthetic potency of propofol in the rat is reduced by simultaneous intravenous administration of lignocaine. Eur J Anaesthesiol.. 1999;16:315-9.

Eriksson M. Prilocaine reduces injection pain caused by propo- fol. Acta Anaesthesiol Scand.. 1995;39:210-3.

Egan TD, Kern SE, Muir KT. Remifentanil by bolus injection: a safety, pharmacokinetic, pharmacodynamic, and age effect investigation in human volunteers. Br J Anaesth.. 2004;92:335-43.

La Pierre CD, Johnson KB, Randall BR. A simulation study of common propofol and propofol-opioid dosing regimens for upper endoscopy. Anesthesiology.. 2012;117:252-62.

Drover DR, Litalien C, Wellis V. Determination of the pharmacodynamic interaction of propofol and remifentanil dur- ing esophagogastroduodenoscopy in children. Anesthesiology.. 2004;100:1382-6.

Jeong CW, Lee SH, Ju J. The effect of priming injection of different doses of remifentanil on injection pain of microemul- sion propofol premixed with lidocaine. Korean J Anesthesiol.. 2011;60:78-82.

Fidler M, Kern SE. Flexible interaction model for com- plex interactions of multiple anesthetics. Anesthesiology.. 2006;105:286-96.

Roehm KD, Piper SN, Maleck WH. Prevention of propofol-induced injection pain by remifentanil: a placebo- controlled comparison with lidocaine. Anaesthesia.. 2003;58:165-70.

Lee JR, Jung CW, Lee YW. Reduction of pain during induction with target-controlled propofol and remifentanil. Br J Anaesth.. 2007;99:876-80.

Basaranoglu G, Erden V, Delatioglu H. Reduction of pain on injection of propofol using meperidine and remifentanil. Eur J Anaesthesiol.. 2005;22:890-2.

Iyilikci L, Balkan BK, Gokel E. The effects of alfentanil or remifentanil pretreatment on propofol injection pain. J Clin Anesth.. 2004;16:499-502.

Lee JY, Yang HJ, Choi SH. The optimal effect-site concentration of remifentanil to attenuate the pain caused by propofol. Korean J Anesthesiol.. 2012;63:108-12.

Batra YK, Al-Qattan AR, Ward VD. Remifentanil pretreat- ment for propofol injection pain in children. Can J Anaesth.. 2004;51:519-20.

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