A comparative prospective study on efficacy of premedication with intravenous paracetamol vs 6% hydroxy ethyl starch for reduction of propofol induced local pain

Background & objective: A wide variety of approaches have been tried to reduce propofol-induced pain including physical and pharmacological methods. As there are very few studies on this topic, we decided to conduct a study to compare the effectiveness of pretreatment with i.v. paracetamol with that of 6% hydroxy ethyl starch (HES) to reduce pain induced by propofol injection. Methodology: The prospective comparative observational study was conducted on patients who belonged to American Society of Anesthesiologists (ASA) class I and II and were to undergo general anesthesia. A total of 60 patients were distributed into two groups; Group HES patients received 100 mL hydroxy ethyl starch (HES) intravenously, and Group P received 100 mL inj. paracetamol IV before the propofol injection. We evaluated the pain on the injection of propofol using verbal rating scale (VRS) and noticed any associated behavioral signs. Hemodynamix parameters and the Perfusion Index (PI) were monitored. Results: Pain experienced by the HES group expressed in terms of VRS score was comparatively higher with early onset of pain (at 1 sec) whereas participants in IV paracetamol started experiencing pain at 4 sec. There was no significant difference between both groups in terms of Heart Rate (HR) Systolic Blood Pressure (SBP), Mean Arterial Pressure ( MAP), and Perfusion Index (PI). Conclusion: The present study found that IV paracetamol is more effective in reducing the propofol-induced local pain compared to hydroxy ethyl starch solution IV. Hence it is preferable as a pretreatment to provide pain relief to the patients. Abbreviations: COX: cyclooxygenase , HES: hydroxy ethyl starch, MAP: Mean Arterial Pressure, PI: Perfusion Index, VRS: verbal rating scale Keywords: Analgesia; Injection; Propofol; Paracetamol; Premedication; Pain Management Citation: Shivakumar G, Kiran AV, Ramegowda DS, Halagatti C. A comparative prospective study on efficacy of premedication with intravenous paracetamol vs 6% hydroxy ethyl starch for reduction of propofol induced local pain. Anaesth. pain intensive care 2025;29(2):307-311. DOI: 10.35975/apic.v29i2.2453 Received: May 09, 2024; Reviewed: October 26, 2024; Accepted: January 01, 2025