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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
PEDIATRIC ORIGINAL ARTICLES
Minerva Anestesiologica 2007 Aprile;73(4):219-23
Prevention of pain on injection of propofol: a comparison of remifentanil with alfentanil in children
Rahman Al-Refai A., Al-Mujadi H., Petrova Ivanova M., Marzouk H. M., Batra Y. K., Al-Qattan A. R.
Department of Anesthesia and Intensive Care, Al-Sabah Hospital, Kuwait
Aim. Propofol has a high incidence of pain on injection, particularly when a vein on the back of hand is used. Administration of lidocaine, either before or mixed with propofol remains the most widely used method to attenuate this pain. The use of opioids such as alfentanil and fentanyl has been found to decrease pain induced by propofol injection. The purpose of this study was to evaluate the effects of different doses of remifentanil and alfentanil in minimizing the pain caused by propofol.
Methods. In this randomized, double-blind, placebo-controlled study, healthy premedicated children between the age group of 5-12 years admitted for adenotonsillectomy were randomly allocated to one of 6 treatment groups. Group I: remifentanil 0.25 µg kg-1; Group II: remifentanil 0.50 µg kg-1; Group III: alfentanil 15 µg kg-1; Group IV: alfentanil 20 µg kg-1 60 s prior to propofol mixed with 1 mL of 0.9% normal saline; Group V: lidocaine 1 mL of 1% (10 mg) added to 100 mg of propofol and Group VI: normal saline. During the injection of propofol (3 mg kg-1) pain perception was assessed with a four-point behavioural scale: none, mild, moderate, or severe.
Results. There were 52 subjects in Group I, 51 in Group II, 49 in Group III, 52 in Group IV, 52 in Group V and 52 in Group VI; 63.46% of patients in Group I, 39.21% in Group II, 38.77% in Group III, 36.53% in Group IV, 38.46% in Group V and 84.61% in Group VI experienced pain. Statistically, Groups II, III, IV and V were significantly better than placebo in the reduction of propofol pain (P<0.0001). Groups II, III and IV significantly reduced the pain in comparison with Group I (P<0.001).
Conclusion. Pretreatment with intravenous remifentanil 0.5 µg kg-1, alfentanil 15 µg kg-1 and 20 µg kg-1 were equally effective in reducing pain associated with propofol injection in children between the age group of 5-12 years.