Prevention of pain from propofol injection

Propofol is a sedative-hypnotic drug used to provide sedation or anaesthesia in operating rooms, critical care units, and emergency departments. Its popularity is not surprising. It has a rapid onset, is easily titrated, allows a smooth emergence from anaesthesia,1 and has other benefits such as preventing nausea or vomiting⇑.2

Propofol has serious side effects including hypotension and respiratory depression.1 However, these risks are well understood and readily mitigated when it is administered by experienced clinicians in appropriate environments. Pain after intravenous injection is one of the most common adverse effects but is much less well understood and poorly managed. In the linked systematic review and meta-analysis (doi:10.1136/bmj.d1110), Jalota and colleagues compared the effects of different interventions for the prevention of pain after propofol injection.3

Pain occurs in 70% of untreated patients,4 and it has been ranked by expert anaesthesiologists as the third most common avoidable adverse event related to anaesthesia.5 A previous systematic review found that a modified Bier’s block was the most effective intervention for preventing …