The results of this narrative review and published systematic reviews suggest that to reduce the risk of pain during injection with propofol one should use a lipid emulsion of propofol, injected into a large vein, preceded by lidocaine 0.5 mg/kg with venous compression for 30–120 s. The addition of other compounds can also be recommended, and ketamine 0.4 mg/kg (adult dose) may be the additional drug of choice, particularly because the combination of ketamine and propofol (ketofol) has added therapeutic benefits. In children Emla cream is an option, but to be effective it must be applied about 4 h before propofol is injected.
Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, Oxford, UK
Correspondence to Jeffrey K. Aronson, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK. E-mail: email@example.com
Editor: R E Ferner, MSc, MD, FRCP, Director of the West Midlands Centre for Adverse Drug Reaction Reporting and Consultant Physician at City Hospital, Birmingham, UK. Assistant Editor: Mr C Anton, MA, MEng. Editorial Board: Australia: Dr M Kennedy, Professor G M Shenfield, Denmark: Professor J S Schou; England: Dr J K Aronson; India: Professor N Gogtay; Netherlands: Professor C J van Boxtel, Dr B H Ch Stricker; New Zealand: Dr T Maling; Scotland: Dr D N Bateman; Wales: Professor P A Routledge.