Valsalva Manoeuvre and Intravenous Dexmedetomidine on Attenuating Pain During Propofol Injection in Upper GIT Endoscopy
Condition: Injection Site Irritation
Study type: Interventional

Summary: 
      No previous study has cited the use of the Valsalva manoeuvre for the reduction of pain on
      propofol injection in comparison with dexmedetomidine injection. Therefore, investigators
      plan a study to evaluate the analgesic efficacy of the Valsalva manoeuvre in alleviating pain
      during propofol injection as compared to dexmedetomidine injection.
    

Detailed description: 
      Propofol is a commonly used anaesthetic for inducing general anaesthesia. Pain on propofol
      injection is distressing and is one of the limitations of its use. Propofol is a phenol
      compound, which irritates nerve endings on the venous endothelium to produce immediate pain,
      whereas delayed pain is mediated by the release of bradykinin. Bradykinin causes vasodilation
      and increases venous permeability, thereby facilitating contact of the aqueous phase of
      propofol with nerve endings. Delayed pain occurs 10-20 seconds after injection.

      Various methods have been tried so far to reduce pain on propofol injection. A commonly used
      technique is lignocaine either as pre-treatment or mixed with propofol. Other methods include
      the use of butorphanol, ondansetron, metoclopramide, opioid, or thiopentone. Propofol
      injection into a large vein, pre-injection cooling, or warming of propofol have also been
      investigated.

      The Valsalva manoeuvre is a physiological technique, used in the reduction of pain associated
      with several procedures. The Valsalva manoeuvre alleviates both the somatic and psychological
      aspects of painful procedures.

      Dexmedetomidine is an alpha-2 adrenoceptor agonist that has analgesic and sedative
      properties, it has been evaluated for reducing the incidence and intensity of
      propofol-induced pain, but reported results are inconsistent.

      in this study, investigators will study the effect of Valsalva manoeuvre as compared with
      dexmedetomidine injection in reducing the pain associated with propofol injection in upper
      gastrointestinal endoscopies.
    

Intervention name(s): Valsalva Manoeuvre; Dexmedetomidine Injection [Precedex]; normal Saline
Intervention type(s): Other; Drug; Drug
Intervention description(s): Blowing into rubber tubing connected to a sphygmomanometer and raising the mercury column to 30 mmHg for at least 20 seconds; The study drugs will be kept at room temperature, preservative-free and will be prepared by an independent anaesthetist into 5 ml of total volume with the addition of 0.9 % normal saline. Tourniquet will be left inflated for 1 minute. Dexmedetomidine mixture and saline will be injected over 5 seconds. After the injection of the drugs, the tourniquet will be released; 5 ml saline will be administered.
Other intervention name(s): Precedex; saline
Intervention MeSH terms: Dexmedetomidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Prevention
Keywords: Propofol injection pain; Dexmedetomidine; Valsalva Maneuver