The effect of combined ephedrine and lidocaine pretreatment on pain and hemodynamic changes due to propofol injection

ObjectivesInjection pain and hypotension are two main adverse effects of propofol that discourage uniform acceptation. The aim of this study was to compare the effect of ephedrine-lidocaine combination with lidocaine and ephedrine alone on injection pain and hemodynamic changes caused by propofol injection.MethodsOne hundred and sixty five patients were randomly allocated to five groups to receive either lidocaine 0.5 mg/kg (Group L) alone, ephedrine 30 μg/kg (Group E30) alone, ephedrine 70 μg/kg (Group E70) alone, lidocaine 0.5 mg/kg-ephedrine 30 μg/kg Group LE, or 2 mL saline (Group S). One minute after the respective study solution was given propofol 2 mg/kg was injected. Face pain scale and verbal rating scale were then evaluated. The mean arterial blood pressure (MAP) and heart rate (HR) were recorded before injection of the test solution, just before the intubation, and 1 minute after intubation.ResultsPatients in the Group L and Group LE showed significantly smaller pain scores compared with the saline group (Group S) [95% confidence interval (CI) 0.50–1.50; p = 0.003 and 95% CI 1.000–1.500; p = 0.004, respectively). The pain scores in Group E30 and Group E70 failed to show a significant difference with that of the Group S (p = 0.193 and p = 0.184, respectively). The changes of MAP before and after propofol injection between the Group L versus Group E30, Group E70, and Group LE were found to be significant (95% CI 5.27–14.49; p = 0.000), (95% CI 4.72–16.39; p = 0.001), and (95% CI 5.94–16.47; p = 0.001), respectively. The HR changes, before and after propofol injection, tended to be smaller in ephedrine groups than in Group L and Group S (p < 0.05).ConclusionPretreatment with combination of small-dose ephedrine and lidocaine could reduce the incidence and intensity of propofol-induced pain and also result in more stable hemodynamic profile, but however, the combination of two drugs failed to work better in further reduction of pain.