Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial


Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran


Background: Painful sensation has been reported after propofol injection in most of the patients but no definite mechanism for this painful sensation has been proposed yet. The present randomized clinical trial compares analgesic effect of ondansetron, magnesium sulphate (MS) and placebo on patients after propofol 2% injection.
Materials and Methods: The present randomized clinical trial with parallel design was performed on 90 patients American Society of Anesthesiologists I-II undergoing general anesthesia within vitrectomy operation with propofol induction. Subjects were randomly allocated into three groups with 30 patients each: (1) MS group (2) ondansetron group and (3) normal saline (NS) group as placebo group. Anesthesia induction and maintenance were the same between groups. Pain intensity of propofol injection in subjects was assessed by a four-point scale (none 0, mild 1, moderate 2 and severe 3) at four time intervals (5, 10, 20 and 25 s) after injection.
Results: MS and ondansetron had significant impacts on pain reduction after propofol 2% injection in comparison with NS as placebo. Comparing two trial groups did not have any significant priority for analgesic impact.
Conclusion: Using ondansetron or MS had no priority on each other on declining propofol injection induced pain.


Picard P, Tramèr MR. Prevention of pain on injection with propofol: A quantitative systematic review. Anesth Analg 2000;90:963-9.  Back to cited text no. 1
Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: A comparison of lidocaine with alfentanil. Anesth Analg 1996;82:469-71.  Back to cited text no. 2
Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 1999;88:1085-91.  Back to cited text no. 3
Bachmann-Mennenga B, Ohlmer A, Boedeker RH, Mann M, Mühlenbruch B, Heesen M. Preventing pain during injection of propofol: Effects of a new emulsion with lidocaine addition. Eur J Anaesthesiol 2007;24:33-8.  Back to cited text no. 4
Bachmann-Mennenga B, Ohlmer A, Heesen M. Incidence of pain after intravenous injection of a medium-/long-chain triglyceride emulsion of propofol. An observational study in 1375 patients. Arzneimittelforschung 2003;53:621-6.  Back to cited text no. 5
Ye JH, Mui WC, Ren J, Hunt TE, Wu WH, Zbuzek VK. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg 1997;85:1116-21.  Back to cited text no. 6
Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: A randomized, controlled, double-blinded study. Anesth Analg 1999;89:197-9.  Back to cited text no. 7
Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection: A randomised, double-blind controlled comparison with lidocaine. Anaesthesia 2001;56:902-5.  Back to cited text no. 8
Memiº D, Turan A, Karamanlioglu B, Kaya G, Pamukçu Z. The prevention of propofol injection pain by tramadol or ondansetron. Eur J Anaesthesiol 2002;19:47-51.  Back to cited text no. 9
Faiz SH, Rahimzadeh P, Sakhaei M, Imani F, Derakhshan P. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries. J Res Med Sci 2012;17:918-22.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
Draškoviæ B, Kneževiæ S, Radovanoviæ D, Rakiæ G. Ondansetron, alfentanil and nitrous oxide in the prevention of pain on injection of propofol. Srp Arh Celok Lek 2013;141:61-5.  Back to cited text no. 11
Klement W, Arndt JO. Pain on injection of propofol: Effects of concentration and diluent. Br J Anaesth 1991;67:281-4.  Back to cited text no. 12
Scott RP, Saunders DA, Norman J. Propofol: Clinical strategies for preventing the pain of injection. Anaesthesia 1988;43:492-4.  Back to cited text no. 13
Lee EH, Lee SH, Park DY, Ki KH, Lee EK, Lee DH, et al. Physicochemical properties, pharmacokinetics, and pharmacodynamics of a reformulated microemulsion propofol in rats. Anesthesiology 2008;109:436-47.  Back to cited text no. 14
Sim JY, Lee SH, Park DY, Jung JA, Ki KH, Lee DH, et al. Pain on injection with microemulsion propofol. Br J Clin Pharmacol 2009;67:316-25.  Back to cited text no. 15
Yull DN, Barkshire KF, Dexter T. Pretreatment with ketorolac and venous occlusion to reduce pain on injection of propofol. Anaesthesia 2000;55:284-7.  Back to cited text no. 16
McCrirrick A, Hunter S. Pain on injection of propofol: The effect of injectate temperature. Anaesthesia 1990;45:443-4.  Back to cited text no. 17
Nakane M, Iwama H. A potential mechanism of propofol-induced pain on injection based on studies using nafamostat mesilate. Br J Anaesth 1999;83:397-404.  Back to cited text no. 18
Cheong MA, Kim KS, Choi WJ. Ephedrine reduces the pain from propofol injection. Anesth Analg 2002;95:1293-6.  Back to cited text no. 19
Agarwal A, Ansari MF, Gupta D, Pandey R, Raza M, Singh PK, et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg 2004;98:683-6.  Back to cited text no. 20
Roczniak W, Wróbel J, Dolczak L, Nowak P. Influence of Central noradrenergic system lesion on the serotoninergic 5-HT3 receptor mediated analgesia in rats. Adv Clin Exp Med 2013;22:629-38.  Back to cited text no. 21
Nam M, Yoon H. Effect of ondansetron combined with dexamethasone on postoperative nausea and vomiting and pain of patients with laparoscopic hysterectomy. J Korean Acad Nurs 2009;39:44-52.  Back to cited text no. 22
Peroutka SJ, Snyder SH. Antiemetics: Neurotransmitter receptor binding predicts therapeutic actions. Lancet 1982;1:658-9.  Back to cited text no. 23
Jellish WS, Leonetti JP, Sawicki K, Anderson D, Origitano TC. Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery. Otolaryngol Head Neck Surg 2006;135:175-81.  Back to cited text no. 24
Lee SK. Pain on injection with propofol. Korean J Anesthesiol 2010;59:297-8.  Back to cited text no. 25
Singh DK, Jindal P, Singh G. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth 2011;5:50-4.  Back to cited text no. 26
[PUBMED]  Medknow Journal