Effectiveness and Safety of 5-HT3 Receptor Antagonists in Preventing Propofol Injection Induced Pain: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Shuying ,  WANG Xiao

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

WANG Xiao, Email: wangxiao2005_1@hotmail.com

Keywords：

5-HT3 receptor antagonist; Propofol injection induced pain; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130078

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in preventing propofol injection induced pain.
Methods 　Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2012), CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software.
Results 　A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that: a) the incidence of propofol injection induced pain in the 5-HT3 group was obviously lower than the control group (RR=0.14, 95%CI 0.09 to 0.21, P lt;0.000 01); b) as to the severity of pain, there was no statistical difference between the two groups (RR=0.84, 95%CI 0.56 to 1.26, P=0.39); the 5-HT3 group was obviously lower that the control group in the incidence of both moderate pain (RR=0.25, 95%CI 0.19 to 0.34, P lt;0.000 01) and severe pain (RR=0.16, 95%CI 0.10 to 0.24, P lt;0.000 01); and c) as to the incidence of postoperative adverse reaction: the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting (RR=0.19, 95%CI 0.11 to 0.34, P lt;0.000 01) and shivering (RR=0.20, 95%CI 0.12 to 0.33, P lt;0.000 01) as well.
Conclusion 　5-HT3 receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.

Citation： LI Shuying,WANG Xiao. Effectiveness and Safety of 5-HT3 Receptor Antagonists in Preventing Propofol Injection Induced Pain: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(4): 452-460. doi: 10.7507/1672-2531.20130078 Copy

1.	Agarwal A, Ansari M, Gupta D, et al. Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection. Anesth Analg, 2004, 98 (3): 683-686.
2.	Habib AS, Gsn TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth, 2004, 51(4): 326-341.
3.	Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth, 2001, 47(10): 1008-1018.
4.	刘启敏, 周建敏, 邹筱萌, 等. 昂丹司琼联合小剂量舒芬太尼预防异丙酚注射痛的临床观察. 海峡药学, 2011, 23(4): 114-115.
5.	朱明. 昂丹司琼与利多卡因预防异丙酚注射痛的对照研究. 山西医药杂志, 2012, 41(3): 263-265.
6.	严映霞, 牟镇, 伍智慧. 低温﹑昂丹司琼﹑利多卡因单用和合用对丙泊酚注射痛的防治比较.中国社区医师·医学专业, 2011, 13(32): 175-176.
7.	陆宏. 静脉注射昂丹司琼对丙泊酚注射痛的预防作用. 牡丹江医学院学报, 2011, 32(5): 39-40.
8.	曹东航, 丁进峰, 王明仓, 等. 利多卡因和恩丹西酮减轻异丙酚注射痛的效果比较. 现代医药卫生, 2005, 21(19): 2578-2579.
9.	马玉姗, 林雪梅, 周俊. 格拉司琼复合利多卡因减轻异丙酚注射痛的随机双盲对照研究. 四川大学学报(医学版), 2009, 40(3): 536-538.
10.	傅海青. 格拉司琼复合利多卡因静脉预处理减轻异丙酚所致注射痛和呕吐的临床观察. 中国药房, 2010, 21(16): 1476-1478.
11.	刘枫, 葛衡江, 周蓉. 托烷司琼对丙泊酚静脉注射痛的预防作用. 中国医院药学杂志, 2006, 26(2): 192-193.
12.	邵丽丽, 吕黄伟, 田阿勇. 托烷司琼复合利多卡因预防丙泊酚注射痛的疗效观察. 中国血液流变学杂志, 2011, 21(2): 284-286.
13.	涂昕祥. 预防丙泊酚注射痛的几种方法评估. 河北医学, 2010, 16(7): 847-849.
14.	Singh DK, Jindal P, Singh P. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth, 2011, 5(1): 50-54.
15.	Ambesh SP, Dubey PK, Sinha PK. Ondansetron Pretreatment to Alleviate Pain on Propofol Injection: A Randomized, Controlled, Double-Blinded Study. Anesth Analg, 1999, 89(1): 197-199.
16.	Ahmed A, Sengupta S, Das T. Pre-treatment randomized, control trial with intravenous granisetron to alleviate pain on propofol injection: a double-blind, randomized, controlled trial. Indian J Anaesh, 2010, 56(2): 135-138.
17.	Dubey PK, Prasad SS. Pain on Injection of Propofol: The Effect of Granisetron Pretreatment. Clin J Pain, 2003, 19(2): 121-124..
18.	Zahedi H, Maleki A, Rostami G. Gholamreza Rostami. Ondansetron Pretreatment reduces pain on injection of propofol. Acta Med Iran, 2012, 50(4): 239-243.
19.	Julian PT Higgins, Sally Green. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
20.	Polat R, Aktay M, Ozlu O. The effects of remifentanil, lidocaine, metoclopramide, or ketamine pretreatment on propofol injection pain. Middle East J Anesthesiol. 2012, 21(5):673-7.
21.	闫诺, 杨程. 帕瑞昔布钠防治丙泊酚注射痛的临床观察. 临床麻醉学杂志, 2012, 28(1): 49-50.
22.	Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
23.	Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
24.	Majedi H, Rabiee M, Khan ZH, et al. A comparion of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
25.	欧珊, 叶占勇, 胡玲. 异丙酚复合芬太尼或氯胺酮在无痛肠镜中的对比观察. 局解手术学杂志, 2003, 12(4): 273-274.
26.	Davies AF, Vaddodaria B, Hopwood B, et al. Efficacy of microfiltration in decreasing propofol induced pain. Anaesthesia, 2002, 57(6): 557-561.
27.	Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: acomparision of lidoeaine with alfentanil. Aneath Analg, 1996, 82(3): 469-471.
28.	Memis D, Turan A, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, idocaine, ramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
29.	Ye JH, Mui WC, Ren J, et al. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg, 1997, 85(5): 1116-1121.
30.	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(9): 902-905.

1. Agarwal A, Ansari M, Gupta D, et al. Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection. Anesth Analg, 2004, 98 (3): 683-686.
2. Habib AS, Gsn TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth, 2004, 51(4): 326-341.
3. Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth, 2001, 47(10): 1008-1018.
4. 刘启敏, 周建敏, 邹筱萌, 等. 昂丹司琼联合小剂量舒芬太尼预防异丙酚注射痛的临床观察. 海峡药学, 2011, 23(4): 114-115.
5. 朱明. 昂丹司琼与利多卡因预防异丙酚注射痛的对照研究. 山西医药杂志, 2012, 41(3): 263-265.
6. 严映霞, 牟镇, 伍智慧. 低温﹑昂丹司琼﹑利多卡因单用和合用对丙泊酚注射痛的防治比较.中国社区医师·医学专业, 2011, 13(32): 175-176.
7. 陆宏. 静脉注射昂丹司琼对丙泊酚注射痛的预防作用. 牡丹江医学院学报, 2011, 32(5): 39-40.
8. 曹东航, 丁进峰, 王明仓, 等. 利多卡因和恩丹西酮减轻异丙酚注射痛的效果比较. 现代医药卫生, 2005, 21(19): 2578-2579.
9. 马玉姗, 林雪梅, 周俊. 格拉司琼复合利多卡因减轻异丙酚注射痛的随机双盲对照研究. 四川大学学报(医学版), 2009, 40(3): 536-538.
10. 傅海青. 格拉司琼复合利多卡因静脉预处理减轻异丙酚所致注射痛和呕吐的临床观察. 中国药房, 2010, 21(16): 1476-1478.
11. 刘枫, 葛衡江, 周蓉. 托烷司琼对丙泊酚静脉注射痛的预防作用. 中国医院药学杂志, 2006, 26(2): 192-193.
12. 邵丽丽, 吕黄伟, 田阿勇. 托烷司琼复合利多卡因预防丙泊酚注射痛的疗效观察. 中国血液流变学杂志, 2011, 21(2): 284-286.
13. 涂昕祥. 预防丙泊酚注射痛的几种方法评估. 河北医学, 2010, 16(7): 847-849.
14. Singh DK, Jindal P, Singh P. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth, 2011, 5(1): 50-54.
15. Ambesh SP, Dubey PK, Sinha PK. Ondansetron Pretreatment to Alleviate Pain on Propofol Injection: A Randomized, Controlled, Double-Blinded Study. Anesth Analg, 1999, 89(1): 197-199.
16. Ahmed A, Sengupta S, Das T. Pre-treatment randomized, control trial with intravenous granisetron to alleviate pain on propofol injection: a double-blind, randomized, controlled trial. Indian J Anaesh, 2010, 56(2): 135-138.
17. Dubey PK, Prasad SS. Pain on Injection of Propofol: The Effect of Granisetron Pretreatment. Clin J Pain, 2003, 19(2): 121-124..
18. Zahedi H, Maleki A, Rostami G. Gholamreza Rostami. Ondansetron Pretreatment reduces pain on injection of propofol. Acta Med Iran, 2012, 50(4): 239-243.
19. Julian PT Higgins, Sally Green. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011. Available from: www.cochrane-handbook.org.
20. Polat R, Aktay M, Ozlu O. The effects of remifentanil, lidocaine, metoclopramide, or ketamine pretreatment on propofol injection pain. Middle East J Anesthesiol. 2012, 21(5):673-7.
21. 闫诺, 杨程. 帕瑞昔布钠防治丙泊酚注射痛的临床观察. 临床麻醉学杂志, 2012, 28(1): 49-50.
22. Macario A, Weinger M, Truong P, et al. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg, 1999, 88(5): 1085-1091.
23. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systemaitic review. Anesth Analg, 2000, 90(4): 963-969.
24. Majedi H, Rabiee M, Khan ZH, et al. A comparion of metoclopramide and lidocaine for preventing pain on injection of diazepam. Anesth Analg, 2002, 95(5): 1297-1299.
25. 欧珊, 叶占勇, 胡玲. 异丙酚复合芬太尼或氯胺酮在无痛肠镜中的对比观察. 局解手术学杂志, 2003, 12(4): 273-274.
26. Davies AF, Vaddodaria B, Hopwood B, et al. Efficacy of microfiltration in decreasing propofol induced pain. Anaesthesia, 2002, 57(6): 557-561.
27. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: acomparision of lidoeaine with alfentanil. Aneath Analg, 1996, 82(3): 469-471.
28. Memis D, Turan A, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, idocaine, ramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
29. Ye JH, Mui WC, Ren J, et al. Ondansetron exhibits the properties of a local anesthetic. Anesth Analg, 1997, 85(5): 1116-1121.
30. 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(9): 902-905.

Chinese Journal of Evidence-Based Medicine

Effectiveness and Safety of 5-HT3 Receptor Antagonists in Preventing Propofol Injection Induced Pain: A Meta-Analysis

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