Revista de investigación de procesos orgánicos y farmacéutica molecular

Abstracto

Does Granisetron Pretreatment Relieve Pain Due to Propofol Injection?

Vijaya Sai and Shaila S. Kamath*

ABSTRACT
Background: Propofol is that the most ordinarily used
induction agent, but causes pain on injection in many
patients. Various techniques are tried and tested for
reducing pain thanks to propofol injection with different
results.
Objective: to match the utilization of pretreatment with
granisetron as compared with lignocaine in reducing pain
on propofol injection.
Patients and Methods: 104 patients (ASA I-II) posted for
elective surgeries under general anesthesia were
randomized into two groups and managed as follows:
Group G: 2ml (1mg/ml) granisetron, and group L; 2ml of
twenty-two lignocaine pretreatment using tourniquet
followed by 2ml (20mg) of propofol injection and pain
assessment was done by a independent observer and graded
as either severe, moderate, mild or no pain consistent with
the response of the patients to the injection.
The study was performed in the department of
Anesthesiology, at Kasturba medical college associated
hospitals, at Attavar, Ambedkar circle and Government
Wenlock hospital, Mangalore from September 2012 to July
2014. The study is a double blind, randomized, clinical trial.
The study participants were patients with age group 18-60
years, either sex of ASA physical status 1 and 2 undergoing
elective surgical procedures under general anesthesia.
Patients who refused to give consent, patients with ASA 3
or 4 status, history of allergy to any of the study drug,
hemodynamically unstable patient, those who had
analgesics as premedication, participants with difficult IV
cannulation and pregnant women were not included in the
study. The sample size required for correctly rejecting the
null hypothesis with the power of 80% and 95% confidence
interval was calculated and was determined that 52
participants were required in each of the two groups
receiving either intravenous granisetron (2mg/2ml) or
intravenous lignocaine (40mg/2ml). After approval from the
institute’s scientific and ethics committee and after
obtaining written and informed consent the participant took
part in the study. Participants were assessed pre-operatively
to check against the exclusion criteria of the study. The
participant received premedication with tablet Lorazepam
2mg, the night before surgery. After shifting to operation
room, venous cannulation was done under aseptic
precautions in a large peripheral vein using an 18G cannula
and connected to normal saline or ringer lactate at 10-
l5ml/kg/hr. Participant was then connected to the monitor to
record heart rate, blood pressure and saturation during the
procedure. Venous occlusion of the arm was maintained with
a tourniquet tied 12-15 cms proximal to the puncture site. The
tourniquet was tightened to a point where the intravenous
fluid stopped flowing, thus ensuring venous occlusion.
Participants were randomized to receive intravenously either
granisetron 2ml (1mg/ml) or 2ml of 2% lignocaine
(preservative free) based on the random number table. The
intravenous infusion was then closed during the period of
occlusion to prevent backflow of blood or the injected drug
into the infusion line. After 1 minute of giving the study drug
occlusion was released and the participant received propofol
2mg/kg. The first 2ml bolus was Kamath .104-109 given over
4 seconds and within 15 seconds the patient will be asked to
rate his pain sensation. The same propofol formulation was
used in all the patients. An anesthetist blinded to the study
protocol was made to guage the pain during injection of
propofol employing a four point verbal rating (McCrirrick and
Hunter) scale 4 used in the earlier studies.
Results: In lignocaine group the incidence of pain was 21.2%
compared to 46.2% within the granisetron group.
From our study pre-treatment with lignocaine is proved to be
more effective in controlling pain on propofol injection than
granisetron. However granisetron does reduce pain in
additional than 50% subjects making it an alternate choice
thanks to its additional property to stop postoperative nausea,
vomiting.
Keywords: Dexmedetomidine, etomidate, granisetron,
injection pain, lidocaine