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Prevention of Propofol Injection Pain in Children: A Comparison of Pretreatment with Tramadol and Propofol-Lidocaine Mixture Hale Borazan1 , Osman Sahin1, Ahmet Kececioglu2, M.Selcuk Uluer2, Tayfun Et1, Seref Otelcioglu1

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Propofol is a popular intravenous (iv) anesthetic agent providing fast onset and smooth anesthetic induction with rapid recovery. However, the disadvantage of pain or discomfort during iv injection may be as high as 85% in children when given into small vein on the dorsum of the hand (1-3). Although various drugs have been used to decrease propofol injection pain such as ketamine, lidocaine, alfentanil, remifentanil, and thiopenthal (4-8), it still represents a clinical problem in children, especially in younger children because of the smaller size of the accessible veins (9). The two most commonly used methods are pretreatment of the vein with lidocaine and mixing propofol with lidocaine immediately before injection (3). However, prior or concomittant administration of lidocaine is not effective in all children (9-11).
Tramadol is a centrally-acting drug, which is effective in the treatment of moderate to severe pain. In addition to its systemic effect, the local anesthetic effect of tramadol has been shown in both clinically and laboratory studies (12,13). According to this action, pretreating the vein with iv tramadol has proved to be effective in preventing propofol injection pain in adults, the incidence of tramadol treated patients was 23% vs 69% in the control group (14). However, to date no published data are available for tramadol on reducing propofol injection pain in children. To the best of our knowledge this is the first study of tramadol on preventing propofol injection pain in pediatric population. As the beneficial effect of tramadol on propofol injection pain in adults is already well known, we aimed to investigate the effect of preatreatment with tramadol on reducing both the incidence and severity of propofol injection pain and how it compared with lidocaine in children.
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