Ondansetron Pretreatment to Alleviate Pain Produced by Propofol: A Randomized Controlled Double Blind Study

  • R B Uma Assistant Professor, Department of Anesthesiology
Keywords: Intravenous injection, Injection propofol, Ondansetron, Pain


Introduction: Propofol is a popular drug for the induction of anesthesia. It has the disadvantage of causing pain or discomfort
on injection. Many methods were used to alleviate the pain by using larger veins, and various drugs have been used to nullify
the pain. We conducted randomized, double-blind study of injection ondansetron pretreatment to know whether it reduces pain
produced by propofol injection.
Materials and Methods: 100 American Society of Anaesthesiologists I and II patients posted for minor obstetric procedures
were randomly divided into two groups and one group receiving injection ondansetron. 4 mg (2 ml) and the second group
receiving 0.9% saline intravenously. The venous drainage was blocked at mid arm manually. One-fourth of the total dose of
propofol was injected over a period of 5 s. Pain scores of 0-3 which correspondence to no pain, mild pain, moderate and severe
pain were assessed by blind investigator.
Results: Pain was signifi cantly reduced in the ondansetron group with no signifi cant side effects. The results can be compared
with studies conducted by others.
Conclusions: We concluded that injection of ondansetron 4 mg as pretreatment was effective in alleviating the pain produced
by propofol injection. Ondansetron has got the added advantage of reducing chances of nausea and vomiting.

Author Biography

R B Uma, Assistant Professor, Department of Anesthesiology

Belgaum Institute of Medical Sciences, Belgaum, Karnataka, India


1. Johnson RA, Harper NJ, Chadwick S, Vohra A. Pain on injection of
propofol. Anaesthesia 1998;53:468-76.
2. Sebel PS, Lowdon JD. Propofol: A new intravenous anesthetic.
Anesthesiology 1989;71:260-77.
3. Bryson HM, Fulton BR, Faulds D. Propofol. An update of its use in
anaesthesia and conscious sedation. Drugs 1995;50:513-59.
4. McCulloch MJ, Lees NW. Assessment and modifi cation of pain on
induction with propofol (Diprivan). Anaesthesia 1985;40:1117-20.
5. Doenicke AW, Roizen MF, Rau J, Kellermann W, Babl J. Reducing
pain during propofol injection: The role of the solvent. Anesth Analg
1996;82:472 4.
6. Hennies HH, Friderichs E, Wilsmann K, Flohe L. Effect of the opioid
analgesic tramadol on inactivation of norepinephrine and serotonin.
Biochem Pharmacol 1982;31:1654-5.
7. Wong WH, Cheong KF. Role of tramadol in reducing pain on propofol
injection. Singapore Med J 2001;42:193-5.
8. Ye JH, Mui WC, Ren J, Hunt TE, Wu WH, Zbuzek VK. Ondansetron
exhibits the properties of a local anesthetic. Anesth Analg 1997;85:1116-21.
9. Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate
pain on propofol injection: A randomized, controlled, double-blinded study.
Anesth Analg 1999;89:197-9.
10. 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;56:902-5.
11. Ebrahim Soltani A, Mohammadinasab H, Goudarzi M, Arbabi S,
Mohtaram R, Afkham K, et al. Acupressure using ondansetron versus
metoclopramide on reduction of postoperative nausea and vomiting after
strabismus surgery. Arch Iran Med 2010;13:288-93.
12. Peroutka SJ, Snyder SH. Antiemetics: Neurotransmitter receptor binding
predicts therapeutic actions. Lancet 1982;1:658-9.
13. Boehler M, Mitterschiffthaler G, Schlager A. Korean hand acupressure
reduces postoperative nausea and vomiting after gynecological laparoscopic
surgery. Anesth Analg 2002;94:872-5.
14. Bhardwaj N, Bala I, Kaur C, Chari P. Comparison of ondansetron with
ondansetron plus dexamethasone for antiemetic prophylaxis in children
undergoing strabismus surgery. J Pediatr Ophthalmol Strabismus
15. White PF, Way WL, Trevor AJ. Ketamine – Its pharmacology and
therapeutic uses. Anesthesiology 1982;56:119-36.
16. Scott RP, Saunders DA, Norman J. Propofol: Clinical strategies for
preventing the pain of injection. Anaesthesia 1988;43:492-4.
17. King SY, Davis FM, Wells JE, Murchison DJ, Pryor PJ. Lidocaine for the
prevention of pain due to injection of propofol. Anesth Analg 1992;74:246 9.
18. Mangar D, Holak EJ. Tourniquet at 50 mm Hg followed by intravenous
lidocaine diminishes hand pain associated with propofol injection. Anesth
Analg 1992;74:250-2.
19. Martin SM, Pang WW, Hwang MH. The analgesic effect of tramadol,
metoclopramide, meperidine and lidocaine in ameliorating propofol injection
pain: A comparative study. J Anaesth Clin Pharmacol 1999;15:37 42.
20. Fletcher JE, Seavell CR, Bowen DJ. Pretreatment with alfentanil reduces
pain caused by propofol. Br J Anaesth 1994;72:342-4.
21. Clarke RS, Dundee JW, Garrett RT, McArdle GK, Sutton JA. Adverse
reactions to intravenous anaesthetics - A survey of 100 reports. Br J Anaesth
22. Lee TW, Loewenthal AE, Strachan JA, Todd BD. Pain during injection of
propofol. The effect of prior administration of thiopentone. Anaesthesia
23. McCrirrick A, Hunter S. Pain on injection of propofol: The effect of
injectate temperature. Anaesthesia 1990;45:443-4.
24. Parmar AK, Koay CK. Pain on injection of propofol. A comparison
of cold propofol with propofol premixed with lignocaine. Anaesthesia
1998;53:79 83.
25. Wilkinson D, Anderson M, Gauntlett IS. Pain on injection of propofol:
Modifi cation by nitroglycerin. Anesth Analg 1993;77:1139-42.
26. Briggs LP, White M. The effects of premedication on anaesthesia with
propofol (‘Diprivan’). Postgrad Med J 1985;61 Suppl 3:35-7.
27. Deegan R. Ondansetron: Pharmacology of a specifi c 5HT3-receptor
antagonist. Am J Med Sci 1992;304:373-8.
28. Ali Z, Wu G, Kozlov A, Barasi S. The role of 5HT3 in nociceptive processing
in the rat spinal cord: Results from behavioural and electrophysiological
studies. Neurosci Lett 1996;208:203-7.
29. Gregory RE, Ettinger DS 5-HT3 receptor antagonists for the prevention
of chemotherapy-induced nausea and vomiting. A comparison of their
pharmacology and clinical effi cacy. Drugs 1998;55:173-89.