Comparison of the anti-nociceptive effect of dexmedetomidine with that of clonidine immediately prior to propofol injection in alleviating propofol injection pain


  • Reshma Sultana Department of Anaesthesiology, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
  • Mohammed Mohsin Ali Department of Anaesthesiology, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India



Propofol, Pain, Dexmedetomidine, Clonidine


Background: Propofol is the drug of choice for induction of anaesthesia because of its rapid onset and short duration of action, easy titration, and favourable profile for side effects. But three out of five patients experience pain on injection of propofol.  Alleviation of Propofol injection pain (PIP) is thus a major concern and several interventions have been investigated to alleviate the pain associated with propofol injection. Clonidine was found to alleviate the pain of injected propofol effectively. Dexmedetomidine is also an alpha-2 adrenoceptor agonist but is more selective than clonidine and has analgesic and sedative properties. The aim of the study was to compare the anti-nociceptive effect of dexmedetomidine with that of clonidine immediately prior to propofol injection in alleviating propofol injection pain.

Methods: A randomized controlled study was conducted on 60 patients admitted in Malla Reddy Institute of Medical Sciences, undergoing elective surgeries under general anaesthesia (GA) for 2 years from October 2015 to September 2017. The patients were randomly divided into two groups (30 each). Group A was administered intravenous injection clonidine 0.5 µg/kg. Group B was administered intravenous injection dexmedetomidine 0.5 µg/kg.

Results: In the present study, difference between the study groups in their mean age, mean weight, gender, ASA grading was not found to be statistically significant. The difference between the groups in incidence of pain on propofol injection was found to be significant statistically. The mean baseline heart rate was declining and mean arterial blood pressure was increasing in both the groups but the difference was not found to be statistically significant.

Conclusions: Pre-treatment with 0.5 µg/kg of IV dexmedetomidine is more effective as compared to IV clonidine in alleviating propofol injection pain.



Marik PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10(29):3639-49.

Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011;342:1110.

Koo SW, Cho SJ, Kim YK, Ham KD, Hwang JH. Small-dose ketamine reduces the pain of propofol injection. Anesth Analg. 2006;103(6):1444-7.

Walker BJ, Neal JM, Mulroy MF, Humsi JA, Bittner RC, Donald SB. Lidocaine pretreatment with tourniquet versus lidocaine-propofol admixture for attenuating propofol injection pain: a randomized controlled trial. Reg Anesth Pain Med. 2011;36(1):41-5.

Ahmed A, Sengupta S, Das T, Rudra A, Iqbal A. Pre-treatment with intravenous granisetron to alleviate pain on propofol injection: A double-blind, randomized, controlled trial. Indian J Anaesth. 2012;56(2):135-8.

Singh DK, Jindal P, Singh G. Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine. Saudi J Anaesth. 2011;5(1):50-4.

Lee JH, Jung SY, Kim MH, Cho K. The effect of dexmedetomidine on propofol injection pain. Korean J Anesthesiol. 2014;67:30-1.

Uzun S, Karagoz H, Kose A, Canbay O, Ozgen S. Dexmedetomidine for prevention of propofol injection pain.J Anaesth Clin Pharmacol. 2008;24:406‑8.

Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg. 1999;88(5):1085-91.

Ayoglu H, Altunkaya H, Ozer Y, Yapakçi O, Cukdar G, Ozkoçak I. Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? Eur J Anaesthesiol. 2007;24:541-5.

Turan A, Memis D, Kaya G, Karamanlioglu B. The prevention of pain from injection of propofol by dexmedetomidine and comparison with lidocaine. Can J Anaesth. 2005;52(5):548-9.

Picard P, Tramèr MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90(4):963-9.

Yoshikawa T, Wajima Z, Ogura A, Inoue T, Ogawa R. Orally administered clonidine significantly reduces pain during injection of propofol. Br J Anaesth. 2001;86(6):874-6.

Desousa KA. Pain on propofol injection: Causes and remedies. Indian J Pharmacol. 2016;48(6):617-23.

He L, Xu JM, He T, Liu L, Zhu R. Dexmedetomidine pretreatment alleviates propofol injection pain. Ups J Med Sci. 2014;119(4):338-42.

Rasmussen KG, Ritter MJ. Anesthetic-induced pain on injection in electroconvulsive therapy: review of the literature and suggestions for prevention. J ECT. 2014;30(3):203-9.

Briggs LP, Clarke RS, Dundee JW, Moore J, Bahar M, Wright PJ. Use of di-isopropyl phenol as main agent for short procedures. Br J Anaesth. 1981;53(11):1197-202.

Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthesia. 1998;53(5):468-76.

Fischer MJ, Leffler A, Niedermirtl F, Kistner K, Eberhardt M, Reeh PW, et al. The general anesthetic propofol excites nociceptors by activating TRPV1 and TRPA1 rather than GABAA receptors. J Biol Chem. 2010;285(45):34781-92.

Fernandes S, Thombre C. Prevention of propofol injection induced pain: A comparison of acetaminophen with lidocaine. SJAMS. 2016;4(5):1544-48.

Erdivanli B, Altun M, Sezen OK, Colakoğlu SA. Anti-nociceptive, analgesic and pathohistological effects of intrathecal dexmedetomidine and bupivacaine in rats. Rev Bras Anestesiol. 2013;63:183-7.

Sapate M, Andurkar U, Markandeya M, Gore R, Thatte W. To study the effect of injection dexmedetomidine for prevention of pain due to propofol injection and to compare it with injection lignocaine. Rev Bras Anestesiol. 2015;65(6):466-9.






Original Research Articles