Background. The mechanism for pain associated with intravenous administration of propofol is believed to be related to the release of nitric oxide. We hypothesized that pain following propofol injection would be reduced by pretreatment with dexamethasone. Methods. One hundred fourteen female subjects received 5？mL of preservative-free saline, 0.5？mg·kg？1 of lignocaine hydrochloride 10？mg·mL？1 or 0.25？mg·kg？1 of dexamethasone, intravenously, following exsanguination and occlusion of the veins of the arm. This was followed by a 0.5？mg·kg？1 injection of propofol. Pain scores, facial grimacing, arm withdrawal, and vocalization were recorded prior to and at 15 and 30 seconds following the injection of propofol. Results. The incidence of moderate to severe pain following the injection of propofol was significantly decreased with both lidocaine and dexamethasone. Hand withdrawal was also significantly decreased in comparison to saline. Conclusion. Low dose dexamethasone is commonly used as an antiemetic, and, in larger doses, it has been demonstrated to provide prolonged postoperative analgesia. At higher analgesic doses, dexamethasone may also reduce pain associated with the injection of propofol. This effect is probably related to the effect of the steroid on nitric oxide production associated with intravenous propofol injection. 1. Introduction Propofol (Diprivan, 2,6-di-isopropylphenol) was introduced into clinical use in 1986 and has now become the most widely used intravenous anaesthetic, despite the high incidence of localized pain on injection. In studies of propofol injection into an intravenous catheter in a forearm cephalic vein or vein on the back of the hand, the incidence of pain was 68%–72% [1, 2]. The pain is immediate and can be profound, and it has been ranked the seventh out of the 33 anesthesia outcomes deserving high priority for improvement, by a panel of anaesthesiologists from academic and community practices [3]. In addition, the hyperdynamic cardiovascular response to the pain can precipitate adverse events in high-risk patients with history of coronary artery disease and/or abnormal heart rhythm. Clinical strategies designed to alleviate propofol-related pain have been described in the literature including cooling the extremity, dilution of the propofol solution injecting propofol into a large antecubital vein, and the application of topical nitroglycerin on the skin overlying the tip of the intravenous catheter. Injection of lidocaine to prevent propofol injection pain is the most extensively studied technique and is commonly used
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