Propofol Injection Pain in Children
Conditions
Keywords
propofol, Buzzy device, propofol injection pain
Brief summary
Propofol is a drug commonly used for induction of general anesthesia in children as well as adults; however, propofol can cause pain on injection, possibly more frequently in children. One common method of preventing propofol injection pain is the injection of lidocaine just prior to the injection of propofol through an intravenous catheter. This practice is sometimes, but not universally, effective, and involves exposure of patients to an additional drug. Our proposal is to use a non-pharmacologic adjunct in an attempt to attenuate the pain of propofol injection. The Buzzy® personal pain relief device is an FDA-approved product that provides non-pharmacologic relief of pain from minor painful procedures in children. The investigators propose the non-invasive Buzzy® personal pain relief device might prove just as effective at relieving the pain of propofol injection as the injection of intravenous lidocaine just prior to propofol injection. Randomized groups and a blinded observer will be used in this study of 106 children, with one group of patients receiving a current standard of care for reduction of the pain of propofol injection, that is, lidocaine prior to propofol, and one group receiving the placement of the Buzzy® device above the injection site prior to injection of propofol to reduce the pain of propofol injection.
Interventions
DEVICEBuzzy device
Sponsors
Ann & Robert H Lurie Children's Hospital of Chicago
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
12 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
Patients who are in the American Society of Anesthesiologists physical status classification I to III (meaning healthy patients, patients with mild systemic disease, and patients with serious controlled systemic disease) between the ages of 12 and 17 presenting from home for procedures including, but not limited to, upper and lower endoscopy, orthopedic surgery, and medical imaging will be enrolled.
Exclusion criteria
Based on history and physical examination, patients requiring a rapid sequence induction of anesthesia and patients requiring an emergency procedure will be excluded. Standard institutional practice is to place IVs in children over 12 before surgery. There are some patients who, due to needle phobia, may prefer a mask induction of anesthesia, but at this age, but this is the exception rather than the rule. If a child was determined to require a mask induction, they would be excluded from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Non-inferiority of Buzzy pain relief device as compared to intravenous lidocaine at preventing pain on injection of propofol | Every minute starting 1 minute prior to induction of anesthesia, during induction, and after induction of anesthesia for a total of ten minutes | Two scales will be used by the observer to rate the amount of pain, if any, on propofol injection, the FLACC (face, legs, activity, cry, consolability) Scale and the Cameron Four Point Scale for Pain on Propofol Injection. The FLACC Scale is a 0-10 scale where the observer rates pain based on facial expression, movement of the body and legs, vocalization, and reassurability. The Cameron Scale was developed by researchers to specifically rate the pain of propofol injection for a previous study, and uses the presence or absence of grimace, cry, and withdrawal to rate pain on a 0-3 scale. Both scales are being used because the FLACC Scale was not specifically designed for propofol pain, and has some limitations in its application for this purpose; however, the Cameron Scale is limited by its narrow application of three types of expressions of pain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Vital Signs | Every minute starting 1 minute prior to induction of anesthesia, during induction, and after induction of anesthesia for a total of ten minutes | The heart rate and blood pressure will be recorded just prior to induction of anesthesia, when 25% of the induction dose of propofol has been given, and every minute after induction of anesthesia for eight minutes. Heart rate and blood pressure variations will serve as a secondary indicator of pain on propofol injection. |
Countries
United States
Outcome results
None listed