Prevention of propofol-induced pain in children: pretreatment with small doses of ketamine

Abstract Study Objective To evaluate the efficacy of ketamine in preventing propofol injection pain in children. Design Prospective, randomized, double-blinded, placebo-controlled study. Setting University-affiliated hospital. Patients 192 ASA physical status 1 and 2 pediatric patients. Interventions Patients were randomly assigned to 4 groups. Group S (control) received normal saline as a placebo; Group K1, Group K3, and Group K5 received 0.1 mg/kg, 0.3 mg/kg, and 0.5 mg/kg of ketamine, respectively. Fifteen seconds after the ketamine injection, patients were injected with propofol at a rate of 12 mL/min until loss-of-eyelash reflex. Measurement Pain was evaluated blindly at the time of induction using a 4-point scale: 0=no pain, 1=mild pain, 2=moderate pain, and 3=severe pain. Adverse effects were recorded. Characteristics of induction of anesthesia, such as dose of propofol and time from propofol injection to loss of consciousness (induction duration), were noted. Main Results 39 (84.8%) Group S (control) patients had pain. Pretreatment with ketamine reduced the frequency of pain significantly to 56.5%, 17.0%, and 14.9% in Groups K1, K3, and K5, respectively. Furthermore, the frequency of moderate and severe pain in Group K1 (21.8%), Group K3 (6.4%), and Group K5 (4.3%) was significantly ( P P Conclusion Pretreatment with a small dose of ketamine (0.3 mg/kg) reduced the frequency and intensity of propofol injection pain without severe adverse effects.