Pretreatment with a very low dose of intravenous esmolol reduces propofol injection pain

Objectives: Propofol causes considerable pain upon injection, although different methods and propofol formulations have been used to decrease this pain. We aimed to investigate the effect of i.v. esmolol pretreatment on propofol injection pain. Methods: Ninety ASA I-II patients undergoing elective surgery under general anesthesia were randomly assigned into three groups of thirty each. A 20 G cannula was inserted into the dorsum of the nondependent hand. After venous occlusion for one minute, groups E, L and S were pretreated with 5 mg/ml (total 2 ml) esmolol, 40 mg lidocaine and 2 ml saline i.v. respectively. After release of venous occlusion, one fourth of the total propofol dose was administered at a rate of 0.5 ml/sec. During the injection of both pretreatment solution and propofol, patient pain was assessed by using 4 point scale. Heart rate and non-invasive arterial blood pressure values were recorded before induction, just after entubation and five minutes after entubation. Results: Demographic values were similar among groups. Incidence of pain on injection of propofol in the control, esmolol and lidocaine groups was 90%, 33.3%, 50% respectively (p<0.05). Heart rate, systolic arterial pressure, and diastolic arterial pressure values were not different between the groups. Conclusion: Pretreatment with low dose esmolol i.v. seems to be effective in attenuating pain during propofol injection.