Authors: Rawal S et al.
BMJ Open. 2025.
Summary
This randomized, double-blind, placebo-controlled trial evaluated two strategies for reducing pain associated with propofol injection in adult patients undergoing elective surgery. Pain on propofol injection remains a common and distressing problem, with reported incidence as high as 90%. The study compared a nonpharmacologic pressure vibration mechanical device and low-dose ketamine against placebo to determine their relative efficacy in preventing injection-related pain.
A total of 300 patients were randomized, with 275 completing the study and included in analysis. Patients received either saline placebo, intravenous ketamine at 50 μg/kg, or saline combined with application of a pressure vibration device proximal to the intravenous cannula. Propofol was administered in a standardized fashion, and pain was assessed using a validated verbal rating scale. The pressure vibration device group demonstrated the highest incidence of no pain during propofol injection, outperforming both ketamine and placebo. Severe pain was significantly more common in the placebo group, while both ketamine and the vibration device markedly reduced severe pain incidence.
Pain recall one week after surgery was also significantly lower in the pressure vibration and ketamine groups compared with placebo, with the vibration device showing the lowest recall rates. Hemodynamic variables and adverse events were similar across all groups, indicating no additional safety concerns. The authors concluded that the pressure vibration mechanical device was at least as effective as low-dose ketamine in reducing propofol injection pain and offered the advantage of being nonpharmacologic and reusable.
What You Should Know
Propofol injection pain remains common despite widespread mitigation strategies.
A pressure vibration mechanical device significantly reduces both the incidence and severity of injection pain.
The device was at least as effective as low-dose ketamine without pharmacologic side effects.
Pain recall one week later was lowest with the pressure vibration approach.
Key Points
Question: Can a pressure vibration mechanical device prevent propofol injection pain as effectively as low-dose ketamine?
Findings: Pressure vibration reduced pain incidence and severity more than placebo and was at least as effective as ketamine.
Meaning: Nonpharmacologic vibration-based strategies may be a practical and effective alternative for preventing propofol injection pain.
Thank you to BMJ Open for allowing us to summarize this article.