Yunchang MO, Shenhui JIN, Luping HUANG, Yuanyuan PAN, Sijia CHEN, Minyuan ZHANG, Xiuxiu ZHUANG, Junlu WANG, Qinxue DAI

Prevention of propofol injection-related pain using pretreatment transcutaneous electrical acupoint stimulation

Background/aim: This study aimed to study the effect of pretreatment transcutaneous electrical acupoint stimulation (TEAS) in preventing propofol injection-related pain. Materials and methods: A total of 360 patients who were to undergo elective hysteroscopy surgery were randomly divided into the following three groups of 120 patients each: control (Group C), sham TEAS (Group F), and TEAS (Group T). Patients in Group C did not undergo any treatment before surgery; 30 min before the induction of anesthesia, patients in Groups F and T underwent electrical stimulation of the bilateral LI4-PC6 acupoint. Patients in Group F were subjected to feeling flow , while those in Group T were subjected to tolerance flow. The stimulation frequency was 2/100 Hz and the duration of stimulation was 30 min. After the induction of anesthesia, propofol injection-related pain scores, hemodynamic parameters, and adverse reactions were recorded. Results: Of the 360 patients, 324 completed the study. There were significant differences among the groups in terms of the incidence of moderate-to-severe pain. In terms of the four-point scaling method, the end of the radial vein, the cubital vein, and the back of the hand vein differed significantly among the three groups (P = 0.05). Finally, using a numerical rating scale, a significant difference was observed among the three groups in terms of the pain scores in the different veins. Conclusions: Pretreatment TEAS effectively reduces the incidence and severity of propofol injection-related pain, the incidence of postoperative nausea and vomiting, and patient postoperative pain scores.

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1. 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: 1085-1091.
2. Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg 2000; 90: 963-969.
3. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with alfentanil. Anesth Analg 1996; 82: 469-471.
4. Jalota L, Kalira V, George E, Apfel CC. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ 2011; 342: d1110.
5. Yuan CS, Attele AS, Dey L, Lynch JP, Guan X. Transcutaneous electrical acupoint stimulation potentiates analgesic effect of morphine. Analgesia 2002; 42: 899-903.
6. Tsay SL, Cho YC, Chen ML. Acupressure and transcutaneous electrical acupoint stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. Am J Chinese Med 2004; 32: 407-416.
7. Allford MA, Mensah JA. Discomfort on injection: a comparison between two formulations of propofol. Eur J Anaesthesiol 2006; 23: 971-974.
8. Kang HJ, Kwon MY, Choi BM, Koo MS, Jang EJ, Lee MA. Clinical factors affecting the pain on injection of propofol. Korean J Anesthesiol 2010; 58: 239-243.
9. Huang CL, Wang YP, Cheng YJ, Susetio L, Liu CC. The effect of carrier intravenous fluid speed on the injection pain of propofol. Anesth Analg 1995; 81: 1087-1088.
10. Stokes DN, Robson N, Hutton P. Effect of diluting propofol on the incidence of pain on injection and venous sequelae. Br J Anaesth 1989; 62: 202-203.
11. Dewandre J, Van BR, Van HJ, Van AH. A comparison of the 2% and 1% formulations of propofol during anaesthesia for craniotomy. Anaesthesia 1994; 49: 8-12.
12. Davies AF, Vadodaria B, Hopwood B, Dexter T, Conn D. Efficacy of microfiltration in decreasing propofol-induced pain. Anesthesia 2002; 57: 557-561.
13. Ozturk E, Izdes S, Babacan A, Kaya K. Temperature of propofol does not reduce the incidence of injection pain. Anaesthesiology 1998; 89: 1041.
14. McCluskey A, Currer BA, Sayeed I. The efficacy of 5% lidocaineprilocaine (EMLA) cream on pain during intravenous injection of propofol. Anesth Analg 2003; 97: 713-714.
15. Kim K, Sung Kim Y, Lee DK, Lim BG, Kim HZ, Kong MH, Kim NS, Lee IO. Reducing the pain of microemulsion propofol injections: a double-blind, randomized study of three methods of tourniquet and lidocaine. Clin Ther 2013; 35: 1734-1743.
16. Fletcher JE, Seavell CR, Bowen DJ. Pretreatment with alfentanil reduces pain caused by propofol. Br J Anaesth 1994; 72: 342- 344.
17. Tan CH, Onsiong MK, Kua SW. The effect of ketamine pretreatment on propofol injection pain in 100 women. Anaesthesia 1998; 53: 296-307.
18. Galvez-Escalera I, Thorpe CM. The effect of coinduction with midazolam on propofol injection pain. Eur J Anaesthesiol 2004; 21: 579-581.
19. Kim YH, Namgung J, Lim CH. Cisatracurium pretreatment with tourniquet reduces propofol injection pain: a doubleblind randomized controlled trial. J Int Med Res 2014; 42: 360- 367.
20. Canbay O, Celebi N, Arun O, Karagöz AH, Saricaoglu F, Özgen S. Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain. Br J Anaesth 2008; 100: 95-98.
21. Borazan H, Erdem TB, Kececioglu M, Otelcioglu S. Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol. Eur J Anaesthesiol 2010; 27: 253-257.
22. Kam E, Abdul-Latif MS, McCluskey A. Comparison of Propofol-Lipuro with propofol mixed with lidocaine 10 mg on propofol injection pain. Anaesthesia 2004; 59: 1167-1169.
23. Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia 1998; 53: 468-476.
24. Wang B, Tang J, White PF, Naruse R, Sloninsky A, Kariger R, Gold J, Wender RH. Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg 1997; 85: 406-413.
25. Habib AS, Itchon-Ramos N, Phillips-Bute BG, Gan TJ. Transcutaneous acupoint electrical stimulation with the ReliefBand for the prevention of nausea and vomiting during and after cesarean delivery under spinal anesthesia. Anesth Analg 2006; 102: 581-584.
26. Zhang R, Feng XJ, Guan Q, Cui W, Zheng Y, Sun W, Han JS. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Fertil Steril 2011; 96: 912-916.
27. Zárate E, Mingus M, White PF, Chiu JW, Scuderi P, Loskota W, Daneshgari V. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2003; 47: 629-635.
28. Lee BW, Kim SH, So KY. The effect of gender on EC50 of remifentanil to prevent pain during injection of microemulsion propofol. Korean J Anesthesiol 2012; 63: 504-509.
29. Wu Q, Zhang N, Shen Y, Jia Y, Lei W. Influence of polyvinyl chloride infusion extension tube on propofol injection pain. Eur J Anaesthesiol 2014; 31: 663-668.