Effect Of Patient Awareness About Possibility Of Occurrence Of Pain During Propofol Injection On The Rate Of Incidence And Severity Of Pain During Injection .
Condition: Effect of Patient Awareness on Incidence and Severity of Propofol Injection Induced Pain
MeSH terms: Pain
Study type: Observational

Summary: 
      Propofol is the most common intravenous (IV) anesthetic agent, used for anesthesia induction
      and maintenance during surgeries due to its rapid onset and short duration.

      However, the incidence of propofol injection pain occurs in about 20% to 90% of patients that
      can decrease patient satisfaction and safety .

      Awareness of patient about propofol injection pain can affect patient anxiety and stress that
      will be reflected on incidence and severity of occurance of propofol injection pain. In our
      study the effect of patient awareness on propofol injection pain will be evaluated after
      adequate using of the pharmacological and non-pharmacological therapy that have been
      demonstrated to be effective in attenuating injection pain.
    

Detailed description: 
      Propofol is the most common intravenous (IV) anesthetic agent, used for anesthesia induction
      and maintenance during surgeries due to its rapid onset and short duration .

      However, the incidence of propofol injection pain occurs in about 20% to 90% of patients that
      can decrease patient satisfaction and safety .

      The mechanism of propofol injection pain has not been known yet, but many factors are
      involved that include the intrinsic drug property (e.g. emulsion composition, pH of the
      formulation, temperature, injection volume and osmolarity) .

      As the lipid solvent irritates the venous intima and triggers a local kallikrein kinin
      cascade by discharging bradykinin and inflammatory factors, and injection pain occurs when
      peripheral nerve endings are directly exposed to propofol .

      Other factors, including the site of injection, speed of injection, vein size, blood
      buffering, sex and simultaneous use of different drugs, seem to affect the incidence and
      severity of propofol injection pain .

      The incidence and the severity of pain following propofol injection is increased in
      peripheral site of injection , smaller size of the vessels and slow injection and the pain
      can be reduced by rapid injection of propofol into the large sized veins as veins of
      antecubital fossa, however, this is not always practical in clinical practice .

      Propofol injection pain is more common and more sever in females than males and the suggested
      reason of gender difference is due to the mechanical effect that male has a larger venous
      size than female while another factor suggested is the difference of pain sensitivity
      observed between the gender.

      Low education level also increases the incidence and the severity of propofol injection pain
      as high education level will help during the patients' preoperative preparations and will
      reduce preoperative anxiety .

      Psychogenic factors such as anxiety, depression, and fear of pain are frequently observed in
      patients undergoing elective surgery. Among these, preoperative anxiety and pain sensitivity
      has been the most important factors .

      Preoperative anxiety activates the release of neuroendocrine mediators related to stress
      response and negatively affects anesthetic methods, surgical recovery, and postoperative pain
      levels .

      Awareness of patient about propofol injection pain can affect patient anxiety and stress that
      will be reflected on incidence and severity of occurance of propofol injection pain. In our
      study the effect of patient awareness on propofol injection pain will be evaluated after
      adequate using of the pharmacological and non-pharmacological therapy that have been
      demonstrated to be effective in attenuating injection pain.

      Many approaches have been recommended to decrease propofol injection pain including both
      pharmacological (e.g. pre-treatment with Paracetamol , lidocaine, magnesium sulfate, ketamine
      , ondansetron , Granisetron ,and and triglycerides ) .

      It is generally approved that lidocaine is an adequate anesthetic that precludes injection
      pain. However, its adverse cardiovascular and hemodynamic effects and swelling at its
      injection site require to be further studied .
    

Intervention name(s): Awareness about propofol injection induced pain
Intervention type(s): Behavioral
Intervention description(s): The aim of the study is to observe the effect of patient awareness about the possibility of occurrence of pain during propofol injection on the rate of incidence and severity of pain during injection as a primary goal as the pain score of propofol injection pain is the main end point of the study .
Intervention MeSH terms: Propofol
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        the study will be performed on 210 patients , 2 equal groups. Group A (Aware group): who
        will be informed about the possibility of incidence of propofol injection pain Group B ( Un
        aware group) : who will not be informed about the possibility of incidence of propofol
        injection pain
      
Keywords: Propofol injection induced pain; Patient awareness