Pain Prevention During Propofol Infusion in Pediatric: Hypnoanalgesia of the Hand Versus Lidocaine.

Propofol is a hypnotic of choice, because of its speed of action, its dose-effect relationship (allowing titrated inductions), its anti-emetic effect, as well as its delay and its short duration of action. Among its side effects, the pain during its injection occupies a significant part in pediatrics (60% in adults, up to 85% in children).

It is most often described as an unpleasant sensation, discomfort or even a burn at the point of puncture, going up along the path of the vein and can extend to the whole arm. The mechanism of this pain is still poorly understood at this time. Several mechanisms have been mentioned such as activation of the bradykinin cascade, a direct stimulation of the free nociceptive venous nerve endings.A meta-analysis concludes in adults that the two most effective techniques are a puncture site on the ulnar vein and a pretreatment of the vein by Lidocaine. In children, the anatomical differences, the notion of protection of the venous capital from the first vascular approach, whatever the prognosis of the patient and the competence of the operator will influence the choice of the material, the choice of the site and the puncture technique. Several pediatric studies have attempted to reduce this injection pain by other techniques. A panel of products has been tested with different drug orientations or not. The suggestion centered on analgesia of the hand is a powerful technique, adapted to acute pain. The pain sensation will thus be partially or completely replaced by a sensation of a different nature, thus attenuating the nociceptive process. This technique has not been studied during injection with propofol.

Inclusion criteria

• Children from 7 to 14 years old.
• Admitted for programmed or ambulatory surgery under general anesthesia.
• ASA I to II. (ASA1: Normal patient or ASA 2: Patient with moderate systemic abnormality).
• Parents or legal guardians who have signed informed consent to the inclusion visit.

Exclusion criteria

• Children under 7, over 14
• In regulated girls, presence of a pregnancy
• ASA III, IV
• Contraindication to propofol (known hypersensitivity to propofol or to one of its constituents)
• Contraindications to lidocaine (known hypersensitivity to lidocaine hydrochloride, amide bonded local anesthetics or to any of the excipients, patients with recurrent porphyria)
• Contraindications to nitrous oxide
• Patient whose clinical condition requires titration of propofol during induction, for good hemodynamic tolerance.
• Refusal by the child or the parents of intravenous induction.
• Psychological distress (agitation, mental deficiencies, communication disorders, deafness problems).
• Analgesic or sedative treatment within 24 hours before induction.
• Locoregional or perimedullary anesthesia before anesthetic induction.