Republic of Iraq

Ministry of Higher Education & Scientific Research

Al-Furat Al-Awsat Technical University
College of Health & Medical Technologies in Kufa
Department of Anesthesia and intensive care

Graduation research project entitled

Compare between two different propofol temperatures on propofol induce pain during injection

Graduate Research Project

Submitted to Council of Department of Anesthesia and Intensive Care Techniques & College of
Medical Health Technologies - Kufa / Middle Euphrates Technical University In partially meeting the
requirements of a bachelor's degree in anesthesia and intensive care techniques

By Students:

Muntazar hussien ali Mojtaba thabet maki Hassan Youssef Hassan

Ghada abood Hamza Nour Al-Huda Haider Rawan Kamal Saleem
Nour Al-Huda jaseem Zahraa Ali Yahya Zeina Wanaas Louikh
Reda Ali Kazem Awrad Rasem Faraj Wasaan Salem Ekhtaef
Zainab Ali Abaes Nour Tariq Hamid Taiba Haider Hussein
Ghufran Riyad Mustafa Noura Mohi Khudair Murtaja Rasul Hamadi
Sarah Ahmed Salman Zahraa abdlhussain Rania Ahmed Hassan

Supervised By
Mohammed Abdul Zahra Sasaa
MSc. Anesthesia and Intensive Care

2024 AD 1445 AH
‫سنَ لَيَ ۡطغ َٰ َٓى‬ ‫َّل إِ َّن ۡ ِ‬
‫ٱۡلن َٰ َ‬ ‫سنَ َما لَ ۡم يَعۡ لَ ۡم ۝ َك َّ ٓ‬
‫ٱۡلن َٰ َ‬ ‫علَّ َم بِ ۡٱلقَلَ ِم ۝ َ‬
‫علَّ َم ۡ ِ‬ ‫ٱلَّذِي َ‬

‫س َو َرة ُ اَل َعلَ ِ‬

‫ق( ‪)٥-٤‬‬ ‫ُ‬
‫ي ال َعظي ْم)‬
‫صدَقَ هللاُ ال َع ِل ُّ‬
‫( َ‬
 Academic Supervisor Certification

I certify that this proposal of the research is entitled.

comparison between two different propofol temperatures on propofol

induce pain during injection.

Was prepared under my supervision the in the Department of

Anesthesia and Intensive Care Technologies. College of Health &
Medical Technologies Kufa Al-Furta Al-Awsat Technical University as
a partial fulfillment of the requirements for a Bachelor's Degree in
Anesthesia Technologies and Intensive Care.

Supervisor:
Mohammed Abdul Zahra Sasaa
MSc. Anesthesia and Intensive Care
Date: / / 2024

I
 Committee Certificate

We, the Examination committee, certify that we have read this research
project for graduates

comparison between two different propofol temperatures on propofol induce pain during injection

Examined the students:

(Muntazar hussien ali Mojtaba thabet maki Hassan Youssef Hassan

Ghada abood Hamza Nour Al-Huda Haider Rawan Kamal Saleem
Nour Al-Huda jaseem Zahraa Ali Yahya Zeina Wanaas Louikh
Reda Ali Kazem Awrad Rasem Faraj Wasaan Salem Ekhtaef
Zainab Ali Abaes Nour Tariq Hamid Taiba Haider Hussein
Ghufran Riyad Mustafa Noura Mohi Khudair Murtaja Rasul Hamadi
Sarah Ahmed Salman zahraa abdlhussain Rania Ahmed Hassan)

In its contents, this is, in our opinion, acceptable as a research project for
Bachelor's Degree in Anesthesia Techniques and Intensive Care.
Signature:
Name:
Title:
Date: / / 2023
(Chairman)

Signature: Signature: Signature: Signature:

Name: Name: Name: Name:
Title: Title: Title: Title:
Date: / / 2023 Date: / / 2023 Date: / / 2023 Date: / / 2023
(Member) (Member) (Member) (Member)

II
 Acknowledgments:

First and foremost, thanks to God, Lord of the Worlds, who guided us to this and
enabled us to reach this stage. Thanks to him, we have reached this stage, and without
him we would not have been.

We also extend our thanks to our supervisor Ass. Lecturer Mohamed Abdel Zahra for
everything he did for us and for his support and follow-up in this research and his
keenness for us to produce it in the most complete form.

Thanks also extend to everyone who had a hand in completing it and everyone who
provided us with assistance in it, especially the fellow brothers who were patient and
worked hard to present the research. As wonderful as it can be, thanks be to God
alone always and forever.

III
 List of contents:

Subject Page No.

Academic Supervisor Certification I

Committee Certificate II

Acknowledgments III

List of contents IV

List of figures V

List of table VI

List of Abbreviations VII

Abstract

Chapter One: Introduction 1-3

1.1. Introduction 1-2

1.2. Aim of study 3

Chapter two : Literature Review 4-12

2.1. Structure and presentation 4

2.2. Mechanism of action, 2.3. Uses, 2.4. Dose 5

2.5. Side effect 6

2.6. pharmacokinetics 6-8

2.7. pharmacodynamics 9-11

2.8. pharmacodynamics in short 11

2.9. drug interaction, 2.10. Propofol Infusion Syndrome (PRIS) 12

Chapter Three: Method 13-14

Chapter Four: Result 15-16

Chapter Five: Discussion 18-17

Chapter Six: Conclusion And Recommendation 19

Chapter Seven : Refrences 20-21

IV
 List of contents:

Figure subject Figure no.

ampoule and vial of propofol 1

Chemical Structure of propofol 2

Time course of propofol plasma 3

concentration

Mechanism of propofol 4

V
 List of table:

Tables no. Subject tables

1 Divisions of pain and their explanation

2 demographics data

3 intensity of pain into two study groups.

VI
 List of Abbreviations:

Meaning Abbreviations

Milliliter. Ml

milligram Mg

Minutes. Min

Nanogram. ng

Microgram. Mcg

Kilogram. Kg

Percentage. %

Hours. h

American Society of Anesthesiology. ASA

The probability of obtaining a test P-value

statistic is at least as extreme as the
one that was observed, assuming that
the null hypothesis is true.

gamma-aminobutyric acid GABA

total intravenous anaesthesia TIVA

Cerebral perfusion pressure. CPP

VII
 Abstract:

Background:
Propofol is a sedative drug that causes pain during injection, and this is one of
its drawbacks. So we studied cold propofol and compared it with propofol at
room temperature for the purpose of reducing the pain associated with it during
injection.

Objectives:
This study aims to study propofol at two different temperatures (cold, room
temperature) and compare them for the purpose of reducing pain during
injection.

Setting:
Al Sader teaching hospital.
Design study:
prospective randomised clinical trial.

Methods:
The study targeted 60 patients aged from 18-60 under general anesthesia, who
were distributed into two groups A and B, each group containing 30 patients.
Group A was given cold propofol and Group B received propofol at room
temperature, taking into account not to give any analgesic before the injection
to achieve the study accurately. The Degree of pain was graded on a four-point
scale

Results:
No significant difference in the total pain rate for both groups, It was equal for
both and amounted to ( 34%).

Conclusion:
The degree of temperature of propofol has no effect on incidence of pain
during propofol injection, both groups had an incidence rate of 34%.

Keywords:
propofol at room temperature, cold propofol, pain,and general anaesthesia.
Chapter One
Introduction
 Introduction
1.1. Introduction
Propofol is a sedative-hypnotic agent, most widely used intravenous (IV) anesthetic
agent for induction and maintenance of anesthesia as well as for sedation inside and
outside operation theater .It is chemically termed 2,6-diisopropylphenol.The
(1)
formulation was originally approved under the brand name Diprivan .

Ampule and vial of propofol posted on wikipedia

Propofol has a high incidence of pain on injection when compared to other

intravenous anesthetic agents. The pain may not be a serious complication, but most
patients remember it as one of the unpleasant encounters with anesthetists. In one
survey, pain on propofol injection (POPI) stands seventh most important problem in
(2)
the current practice of clinical anesthesia The incidence of pain varies between
28% and 90% in adults during induction of anesthesia.
Many factors appear to affect the incidence of pain on propofol injection. These
include the site of injection, size of vein, speed of injection, propofol concentration in

1
the aqueous phase and the buffering effect of blood. the temperature of propofol,
syringe material and the concomitant use of drugs such as local anesthetics and
(3)
opiates .

Propofol injection is directly related to site of injection and smaller size of the
vessels. When the injection is carried out in a large vein, pain experienced is less
probably due to injection in the midstream leading to minimal contact of propofol
(4)
with the endothelial wall of the vein .
The present study also pointed out that incidence of pain on propofol injection was
different between the different IV sites, and may be severe when the veins on the
(5)
dorsum of the hand .

Propofol is distributed in two phases with an outer aqueous phase and an inner lipid
phase in the propofol emulsion preparation. Only the outer aqueous phase comes into
contact with the intima of the vein, so the concentration of an irritating agent in the
(6)
aqueous phase .
They noticed that slow injection causes more pain than thefast
injection since slow injection may increase the concentration and duration of
exposure of propofol to the vein wall and rapid injection may clear the drug quickly
from the vein and replace it with blood.
The painful sensation from veins probably originates from neural elements within the
vein walls, possibly from free afferent nerve endings between the media and intima.

(7)
The pain-conducting axons probably belong to the myelinated A delta group .
Several investigators have studied pharmacological and nonpharmacological
(8)
strategies for the prevention of pain upon propofol injection .
includes, cooling or diluting the propofol solution, and pretreatment, with drugs
(9) (10)
including lidocaine, ketamine, magnesium sulfate, and triglycerides .

2
1.2. Aim of study

To compare between two different propofol temperatures on propofol induce pain

during injection.

3
Chapter Two
Literature review
 Literature review

2.1. Structure–Activity Relationships and presentation

Structure–Activity Relationships

Propofol consists of a phenol ring substituted with two isopropyl groups . Propofol is
not water soluble, but a 1% aqueous solution (10 mg/mL) is available for intravenous
administration as an oil-in-water emulsion containing soybean oil, glycerol, and egg
lecithin. A history of egg allergy does not necessarily contraindicate the use of
propofol because most egg allergies involve a reaction to egg white (egg albumin),
whereas egg lecithin is extracted from egg yolk. This formulation will often cause
pain during injection that can be decreased by prior injection of lidocaine or less
effectively by mixing lidocaine with propofol prior to injection (2 mL of 1%
lidocaine in 18 mL propofol). Propofol formulations can support the growth of
bacteria, so sterile technique must be observed in preparation and handling. Propofol
should be administered within 6 h of opening the ampule. Sepsis and death have
been linked to contaminated propofol preparations. Current formulations of propofol
contain 0.005% disodium edetate or 0.025% sodium metabisulfite to help retard the
rate of growth of microorganisms; however, these additives do not render the product
“antimicrobial preserved” under United StatesPharmacopeia standards.

4
2.2 Mechanisms of Action:

Propofol induction of general anesthesia may

involve facilitation of inhibitory neurotransmission mediated by GABA A receptor
binding. Propofol allosterically increases binding affinity of GABA for the GABA A
receptor. This receptor, as previously noted, is coupled to a chloride channel, and
activation of the receptor leads to hyperpolarization of the nerve membrane. Propofol
(like most general anesthetics) binds multiple ion channels and receptors.

2.3. Uses Propofol is used:

1. for the induction and maintenance of general anaesthesia

2. for sedation during intensive care and regional anaesthesia, and has
been used
3. in the treatment of refractory nausea and vomiting in patients receiving
chemotherapy and
4. in the treatment of status epilepticus.

2.4. Routes of administration/doses:

Propofol is administered intravenously in a bolus dose of 1.5–2.5 mg/kg for induction

and as an infusion of 4–12 mg/kg/hour for maintenance of anaesthesia in adults.
Children require a bolus dose increase of 50% and an increase of maintenance
infusion by 25–50%. Patients who are elderly or unstable require dose reductions
accordingly (induction 1–1.5 mg/kg, maintenance 3–6 mg/kg/hour). Co-induction of
an opioid and/or benzodiazepine, or administration as premedication, will lower the
required dose of propofol further. Consciousness is lost in about 30–40 seconds, with
emergence occurring approximately after 10 minutes from a single dose. Plasma
concentrations of 2–6 micrograms/ml and 0.5–1.5 micrograms/ml are associated with
hypnosis and sedation, respectively.

5
2.5. Toxicity/side effects:

Pain on injection occurs in up to 28% of subjects. The incidence may be reduced by

the addition of lidocaine (1 ml of 1%), cooling the drug, and the use of large veins.
Addition of lidocaine in quantities >20 mg lidocaine per 200 mg propofol results in
emulsion instability and increases in globule size, which have been associated with
reduced anaesthetic potency in animals. There are case reports of epileptiform
movements, facial paresthesia, and bradycardia, following the administration of
propofol, although the incidence of allergic phenomena is low. The use of propofol
appears to be safe in patients susceptible to porphyria (although urinary porphyrin
concentrations may increase) and malignant hyperpyrexia. There are reports of
11
neurological sequelae and increased mortality complicating long-term use.

2.6. Pharmacokinetics:

A. Absorption:
Propofol is available only for intravenous administration for the induction of general
anesthesia and for moderate to deep sedation.

B. Distribution:
Propofol has a rapid onset of action. Awakening from a single bolus dose is also
rapid due to a very short initial distribution half-life (2–8 min). Most
investigators believe that recovery from propofol is more rapid and is accompanied
by less “hangover”than recovery from methohexital, thiopental, ketamine, or
etomidate. This makes it a good agent for outpatient anesthesia. A smaller induction
dose is recommended in elderly patients because of their smaller Volume of
distribution. Age is also a key factor determining required propofol infusion rates for
TIVA.
C. Biotransformation;
The clearance of propofol exceeds hepatic blood flow, implying the existence of
extrahepatic metabolism.This exceptionally high clearance rate probably contributes
6
to relatively rapid recovery after continuous infusions. Conjugation in the liver results
in inactive metabolites that are eliminated by renal clearance.
The pharmacokinetics of propofol do not appear to be affected by obesity, cirrhosis,
or kidney failure.Use of propofol infusion for long-term sedation of children who are

critically ill or young adult neurosurgical patients has been associated with sporadic
cases of lipemia, metabolic acidosis, and death, the so-termed propofol infusion
syndrome.

D. Excretion;
Although metabolites of propofol are primarily excreted in the urine, chronic kidney
failure does not affect clearance of the parent drug.

Propofol is rapidly metabolized in the liver, and the resulting water-soluble

compounds are presumed to be inactive and excreted through the kidneys. Plasma
clearance is rapid and exceeds hepatic blood flow, thus
indicating the importance of extrahepatic metabolism, which has been confirmed
during the anhepatic phase of liver transplantation. The lungs probably play a major
role in this extrahepatic metabolism and likely account for the elimination of up to
30% of a bolus dose of propofol. The
Rapid plasma clearance explains the more complete recovery from propofol with less
“hangover” than observed with thiopental. As with other intravenous drugs, the
effects of propofol are terminated by redistribution from the plasma
and highly perfused compartments (such as the brain) to poorly perfused
compartments (such as skeletal muscle). A patient usually awakens within 8 to 10
minutes after an induction dose of propofol, similar to the period of decline in plasma
12
concentration after a single bolus dose.

7
Propofol has two pharmacokinetic properties that make it ideal for use as a
continuous intravenous infusion: (1) rapid metabolism and efficient clearance from
plasma, and (2) slow redistribution from poorly perfused compartments
back into the central compartment.

8
2.7. Pharmacodynamics: Effects on Organ Systems

A. Cardiovascular:
The major cardiovascular effect of propofol is a decrease in arterial blood pressure
due to a drop in systemic vascular resistance (inhibition of sympathetic
vasoconstrictor activity), preload, and cardiac contractility.
Hypotension following induction is usually reversed by the stimulation
accompanying laryngoscopy and intubation.Factors associated with propofol induced
hypotension include large doses, rapid injection, and old age. Propofol markedly
impairs the normal arterial baroreflex response to hypotension. Rarely, a marked drop
in preload may lead to a vagally mediated reflex bradycardia.Changes in heart rate
and cardiac output are usually transient and insignificant in healthy patients but may
be severe in patients at the extremes of age, those receiving β-adrenergic blockers, or
those with impaired ventricular function. Although myocardial oxygen consumption
and coronary blood flow usually decrease comparably, coronary sinus lactate
production increases in some patients, indicating some mismatch between myocardial
oxygen supply and demand.

9
B. Respiratory :
Propofol is a profound respiratory depressant that usually causes apnea following an
induction dose.Even when used for conscious sedation in subanesthetic doses,
propofol inhibits hypoxic ventilatory drive and depresses the normal response to
hypercarbia. As a result, only properly educated and qualified personnel should
administer propofol for sedation. Propofol-induced depression of upper airway
reflexes exceeds that of thiopental, allowing
intubation, endoscopy, or laryngeal mask placement in the absence of neuromuscular
blockade. Although propofol can cause histamine release, induction with propofol is
accompanied by a lower incidence of wheezing in asthmatic and nonasthmatic
patients compared with barbiturates or etomidate.

Unlike many other anesthetics, propofol has antiemetic activity. Similar to thiopental
and unlike volatile anesthetics, propofol probably does not enhance neuromuscular
blockade from neuromuscular blocking drugs. Yet, propofol often provides excellent
clinical conditions for endotracheal intubation without the use of neuromuscular
blocking drugs. Unexpected arrhythmias or electrocardiogram changes occurring
during propofol anesthesia should prompt laboratory evaluation for possible
metabolic acidosis, rhabdomyolysis, or hyperkalemia (propofol infusion syndrome).

C. Cerebral :
Propofol decreases cerebral blood flow and intracranial pressure. In patients with
elevated intracranial pressure, propofol can cause a critical reduction in CPP (<50
mm Hg) unless steps are taken to support mean arterial blood pressure. Propofol and
thiopental probably provide a similar degree of cerebral protection during
experimental focal ischemia. Unique propofol are its antipruritic properties. Its
antiemetic effects (requiring a blood propofol concentration of 200 ng/mL) provide
yet another reason for it to be a preferred drug for outpatient anesthesia. Induction is
occasionally accompanied by excitatory phenomena such as muscle twitching,
spontaneous movement, opisthotonus, or hiccupping. Although these reactions may
occasionally mimic tonic–clonic seizures, propofol has anticonvulsant properties and
10
has been used successfully to terminate status epilepticus. Propofol may be safely
administered to epileptic patients. Propofol decreases intraocular pressure. Tolerance
does not develop after long-term propofol infusions. Propofol is an uncommon agent
of physical dependence or addiction; however, both anesthesia personnel and
medically untrained individuals have died while using propofol inappropriately to
induce sleep in nonsurgical settings.

2.8. Pharmacodynamics in shorts:

1. Mechanism of Action: Propofol enhances the activity of the inhibitory

neurotransmitter gamma-aminobutyric acid (GABA) by binding to GABA-A
receptors. This leads to potentiation of GABAergic inhibition, resulting in sedation,
hypnosis, and anesthesia.
2. Sedation and Anesthesia: Propofol produces dose-dependent effects on the level of
sedation and anesthesia. At lower doses, it induces sedation and anxiolysis, while at
higher doses, it produces unconsciousness and anesthesia.
3. Cardiovascular Effects: Propofol can cause dose-dependent cardiovascular
depression, leading to hypotension and bradycardia. These effects are primarily due
to vasodilation and decreased cardiac contractility.
4. Respiratory Effects: Propofol causes respiratory depression by depressing the
responsiveness of the respiratory centers in the brainstem to carbon dioxide and
hypoxia. This can result in hypoventilation and apnea, especially at higher doses or
during rapid administration.
5. Amnestic Effects: Propofol produces amnesia by impairing the encoding and
retrieval of new memories, making it useful for procedures requiring conscious
sedation or anesthesia.
Overall, propofol's pharmacokinetic and pharmacodynamic properties contribute to
its rapid onset, short duration of action, and suitability for induction and maintenance
of anesthesia, as well as sedation in various medical procedure The dosage and
storage conditions for propofol can vary depending on factors such as the patient's
11
age, weight, medical condition, and the intended use of the medication. However,
here are some general guidelines:

2.9. Drug Interactions :

Fentanyl and alfentanil concentrations may be increased with concomitant

administration of propofol. Many clinicians administer a small amount of
midazolam (eg, 30 mcg/kg) prior to induction with propofol; midazolam can reduce
13
the required propofol dose by more than 10%.

2.10. Propofol infusion syndrome (PRIS)

Propofol infusion syndrome (PRIS) is a rare syndrome caused by mitochondrial

dysfunction and characterized by metabolic acidosis, hyperkalemia, rhabdomyolysis,
and fatty liver infiltration. Cardiac complications may
include nonspecific symptoms such as acute refractory bradycardia and right bundle
branch block. It is more common in children, but predisposing factors include
infusion rates of more than 5 mg/kg/h for more than 48 hours in patients with critical
illness receiving vasopressors or glucocorticoids. Early recognition of the syndrome
and discontinuation of the propofol infusion reduce morbidity and mortality rates,
14
which can be as high as 80%.

12
Chapter Three
Method
 Method
The approval for the research was obtained from the Najaf Health Department on
sixty patients ranging in age from 18-60 to assess the severity of the pain.

Patients were divided into groups A and B where each group consisted of thirty
(30) patients. Group A received a cold propofol at a temperature of 4- 8 Celsius
and group B received a room temperature propofol at a temperature of 22- 24
degrees Celsius. and the patient's physical details such as weight and age were
taken before starting the procedure.

We initially administered the medication at 5 cc so that we could ask the patient

whether or not they felt pain or intensity, while emphasizing that neither group
received any analgesic medication or had a painkiller effect before administering
propofol such as ketamine, and lidocaine
The severity of pine was measured of Measured by four scale :

0 No pain Negative response to questioning

I Mild pain Pain reported only in response to questioning

without any behavioral signs

II Moderate pain Pain reported in response to questioning and

accompanied by behavioral signs or pain
reported spontaneously without questioning

III Severe pain Strong vocal response or response accompanied

by facial grimacing , arm withdrawal, or tears

3.1.Table: Divisions of pain and their explanation.

13
Operations ranged from endoscopic and urinary internal surgery to appendectomy,
laparoscopic cholecystectomy, kidney stones and bitterness for
both groups. The patient was asked during the injection if they felt pain or not
and what pain intensity they felt.

Some patients who did not feel pain told us and others from medium to severe,
told us verbally or on their face to feel pain. The muscles of his face were reduced
and he closed his eyes strongly and his limbs were moved to reflect his sense of pain.
There was one case where once she was given medication, she screamed and cried
from the severity of the pain and this case has been excluded to accommodate the full
number of cluster cases.

After the patient entered the state of sleep, our role was completed by asking him
about the pain and the samples were all collected according to this pattern
shown.

Statistical methodology:

The statistical package for social sciences (SPSS) software for Windows, version 26,
was used for entering and analyzing the information that was collected. Rates and
percentages (%) are used to show descriptive statistics. Unrelated t-tests were used to
compare categories of variables across the study groups. The threshold for any
variation or relationship to be considered significant was set at ( 0.05). Finally, using
the 2016 edition of Microsoft Word, the findings are shown in tables and figures with
an explanation for each.

14
Chapter Four
Result
 Results

In this study, sixty patients, who were on the operation theatre list for a different type
of surgery under general anesthesia, were divided into two groups. Group A (n=30)
received cold propofol and Group B (n=30) received propofol with room
temperature. In group A, the average age of the patients was 31.1±1.43 while in
group B, the average age was 32.4±1.26; the mean difference was not statistically
significant between groups (P=0.38). The mean BMI of the patients in group A was
27.1 ±6.8and 29.4±8.9in group B (table 1). Other demographic data showed no
statistical difference in either groups.

4.1.Table: demographics data

15
4.2. Table: intensity of pain into two study groups.

- cold propofol RT propofol P-value

group group

N=30 N=30
No pain F 20 20 -
% 66 66
Mild pain F 5 3 0.04
% 17 10
Moderate pain F 3 2 0.11
% 10 7
Severe pain F 2 5 0.02
% 7 17
Total pain F 10 10 -
% 34 34

RT: room temperature.

Both groups were similar in refer to no pain with a percentage of 66% with statically
insignificant, total pain were also similar and the moderate pain was no differences in
both groups with a p-value equal to 0.11.

Mild pain in cold propofol group were more 17% as campere with room tempreture
10% with a p-value, statically significant less than 0.05, while severe pain were more
faced in group of propofol in room temperature 17% and less with cold propofol
equal to 7% with statically differences with p-value less than 0.05.

16
Chapter Five
Discussion
 DISCUSSION
As we know and presented in the research previously , propofol, a widely used
anesthetic drug due to its unique pharmacological characteristics, such as rapid
onset and short duration, is associated with discomfort during injection. And to
address this problem, we did this study on two different temperatures of propofol
(cold, room temperature) so that we can see if it has a clear effect on reducing
propofol-related pain.

In our study : We did not find a statistically significant difference in the total pain
rate for both groups, It was equal for both and amounted to ( 34%). Both groups were
similar in terms of the statistical result for the “no pain” value, as the percentage was
66%.

And although there was a difference of one case between the two different
temperatures for moderate pain in practice, we did not find a significant statistical
difference, as the results were close or similar, so to speak, as the p-value was equal
to 0.11.

But we found the biggest difference in mild and severe pain, with a clear practical
and statistical difference, and a statistically significant percentage, as the cases that
felt mild and severe pain with cold propofol were only two cases for both, with a
statistical percentage equal to 7% for both. While the cases that felt mild pain with
propofol at room temperature were 6 cases, with a statistical percentage equal to
20%, and those who felt severe pain were 5 cases, and the statistical percentage was
17%, with a clear statically difference in the p-value of less than 0.05 for both groups.

If this indicates anything, it indicates that propofol at room temperature causes

slightly more pain during injection than cold propofol. Despite the similarity and

17
closeness of the statistical results here and here, the tangible results show that there is
a difference, even if it is a small percentage.
The statistical results revealed that the overall percentage of pain was similar for both
groups, but there was a large discrepancy between the two groups when it came to the
results of the percentage of mild and severe pain, as the scale tipped in favor of cold
propofol. This is considered a glimmer of hope for further research into cold
propofol, in the hope that patients will be relieved of the pain associated with it
during injection.
Our research was not the first and unique of its kind in an attempt to investigate
reducing the pain associated with propofol through cooling it. Although the
studies that were conducted did not take cold propofol alone as a source of pain
reduction, most studies mix it with other analgesics and monitor the pain. Taking this
into consideration, Studies and articles, some suggest and others suggest, that cold
propofol may be effective in reducing pain resulting from injections
Such as:
A study published by frontiers in medicine and edited by Nicoleta Stoicea,Summa
Health System, United States, (Received: 01 August 2020 Accepted: 13 April 2021
Published: 07 May 2021) .The study was conducted on 251 patients who underwent
maxillofacial surgery and were distributed into four groups that received
dexmedetomidine alone once and with propofol at a temperature of 4°C once, and
lidocaine. Regardless of the results of the study, which do not concern us in the field
of our current research, the study indicated elsewhere that cooling propofol can
15
reduce the pain associated with it during injection.

A 1997 study published by Department of Anaesthesia, Pamela Youde Nethersole

Eastern Hospital confirmed that the temperature could reduce propofol-related pain.
The scientists studied Macrick and Hunter "the effect of injection temperature on
propofol injection pain. They found that when propofol is administered at 4 8 degrees
Celsius, the incidence of injecting pain can be significantly reduced from 46% to
16
23%. The effectiveness of propofol was not affected".
18
 Chapter Six
Conclusion And Recommendation
 Conclusion

Conclusion: our conclusion showed that, degree of temperature of propofol have not
decreased the total incidence of pain during propofol injection, both groups had an
incidence rate of 34%, severe pain were less with cold propofol as compared with
propofol in the room temperature

Recommendation :

1. Further searching is required with large sample

2. Use of cold propofol (store between 4-10C to prevent severity of pain during
propofol injection
3. Use an additional method for decreasing propofol induced pain rather than a cold
propofol method .

Limitations:

Cold Propofol may affected by room temperature during preparing for cases
that might be influenced the result

19
Chapter Seven
References
References

1. Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application by

Hugh C. Hemmings BS MD PhD
2. 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;88:1085–91. [PubMed] [Google Scholar]
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50 mmHg followed by intravenous lidocaine diminishes hand pain associated with propofol
injection. Anesthesia and Analgesia 1992; 74:250–2.
4. Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of
injection. Anaesthesia. 1988; 43:492–494. PMID: 3261547
5. McCulloch MJ, Lees NW. Assessment and modification of pain on induction with propofol
(Diprivan). Anaesthesia. 1985; 40:1117–1120. PMID: 3878103
6. Klement W, Arndt JO. Pain on injection of propofol: effects of concentration and diluent. Br
J Anaesth. 1991; 67:281–284. PMID: 1911014
7. REVIEW ARTICLE Pain on injection of propofol,1997. Briggs LP, Clarke RSJ, Dundee
JW, Moore J, Bahar M, Wright PJ. Use of di-isopropyl phenol as the main agent for short
procedures. British Journal of Anaesthesia 1981; 53:1197–201
8. Efficacy of the combination of cold propofol and pretreatment with remifentanil on propofol
injection pain.[Google Scholar]
9. Picard P, Trainer MR. Prevention of pain on injection with propofol: a quantitative
systematic review. Anesth Analg. 2000; 90:963–969. PMID: 10735808
10. Intravenous Dexmedetomidine Administration Prior Anesthesia Induction With Propofol at
4°C Attenuates Propofol Injection Pain: A Double-Blind, Randomized, Placebo-Controlled
Trial
11. Edward Scarth, Susan Smith, Drugs in Anaesthesia and Intensive Care FIFTH
EDITIONPublished in the United States of America by Oxford University Press198
Madison Avenue, New York, NY 10016, United States of America Library of Congress
Control Number 2015949834
12. Pardo, Jr., MD, D. Miller, MD, MS BASICS OF ANESTHESIA, SEVENTH EDITION
,1600 John F. Kennedy Blvd.Ste 1800 Philadelphia, PA 19103-2899,2018 by
Elsevier,Section II PHARMACOLOGY AND PHYSIOLOGY, chapter 7 inhaled
anesthetics, page 106

20
13. Morgan & Mikhail’s Clinical Anesthesiology, John F. Butterworth IV, MD, David C.
Mackey, MD,John D. Wasnick, MD, MPH, 2013, 2006, 2002 by McGraw-Hill Education,
LLC, FIFTH EDITION, CHAPTER 9 Intravenous Anesthetics, PAGE 187
14. Pardo, Jr., MD, D. Miller, MD, MS BASICS OF ANESTHESIA, SEVENTH EDITION
,1600 John F. Kennedy Blvd.Ste 1800 Philadelphia, PA 19103-2899,2018 by
Elsevier,chapter 41 critical care medicine page 718
15. McCririck A, Hunter S. Pain on injection of propofol: the effect of injectate temperature.
Anaesth (1990) 45:443–4. doi: 10.1111 j.1365-2044.1990.tb14329.x
16. McCririck A, Hunter S. Pain on injection of propofol: the effect of injectate temperature.
Anesthesia 1990; 45: 443–4.

21
22
 ‫الخالصة‪:‬‬

‫الخلفية العلمية‪ :‬البروبوفول دواء مهدئ يسبب األلم أثناء الحقن وهذا من عيوبه‪ .‬لذلك قمنا بدراسة‬
‫البروبوفول البارد ومقارنته مع البروبوفول في درجة حرارة الغرفة بغرض تقليل األلم المصاحب‬
‫له أثناء الحقن‪.‬‬

‫األهداف‪ :‬تهدف هذه الدراسة إلى دراسة البروبوفول في نوعين مختلفين درجات الحرارة (البرد‪،‬‬
‫درجة حرارة الغرفة) ومقارنتها بغرض تخفيف األلم أثناء الحقن‪.‬‬

‫المكان‪ :‬مستشفى الصدر التعليمي‬

‫دراسة التصميم‪ :‬تجربة سريرية عشوائية مستقبلية‬

‫طرق البحث‪ :‬استهدفت الدراسة ‪ 60‬مريضا تتراوح أعمارهم بين ‪ 60-18‬عاما تحت التخدير‬
‫العام‪ ،‬تم توزيعهم إلى مجموعتين (أ) و (ب)‪ ،‬كل مجموعة تحتوي على ‪ 30‬مريضا‪ .‬أعطيت‬
‫المجموعة (أ) البروبوفول البارد والمجموعة (ب) أعطيت البروبوفول في درجة حرارة الغرفة مع‬
‫مراعاة عدم إعطاء أي مسكن قبل الحقن لتحقيق الدراسة بشكل دقيق‪ .‬تم تصنيف درجة األلم على‬
‫مقياس من أربع نقاط‪.‬‬
‫المنهجية اۡلحصائية‪:‬‬
‫تم استخدام برنامج الحزمة اۡلحصائية للعلوم االجتماعية (‪ )SPSS‬لنظام التشغيل ‪Windows‬‬
‫اۡلصدار ‪ۡ 26‬لدخال وتحليل المعلومات التي تم جمعها‪ .‬تُستخدم المعدالت والنسب المئوية (‪)%‬‬
‫ۡلظهار اۡلحصائيات الوصفية‪ .‬تم استخدام اختبارات ‪ t‬غير ذات صلة لمقارنة فئات المتغيرات‬
‫وأخيرا‪،‬‬
‫ً‬ ‫عبر مجموعات الدراسة‪ .‬تم تحديد عتبة أي اختَّلف أو عَّلقة تعتبر هامة عند (‪.)0.05‬‬
‫باستخدام إصدار ‪ 2016‬من برنامج ‪ ،Microsoft Word‬تظهر النتائج في جداول وأشكال مع‬
‫شرح لكل منها‪.‬‬

‫النتائج‪ :‬ال يوجد فرق كبير في نسبة األلم الكلية لكَّل المجموعتين‪ ،‬وكانت متساوية لكَّل‬
‫المجموعتين وبلغت (‪.)%34‬‬

‫االستنتاج‪ :‬درجة حرارة البروبوفول ليس لها أي تأثير على حدوث األلم أثناء حقن البروبوفول‪،‬‬
‫وكانت نسبة حدوث األلم لدى كَّل المجموعتين ‪.%34‬‬

‫الكلمات المفتاحية‪ :‬البروبوفول في درجة حرارة الغرفة‪ ,‬البروبوفول البارد‪ ,‬االلم والتخدير العام‬

‫‪23‬‬
 ‫جمهورية العراق‬
‫وزارة التعليم العالي والبحث العلمي جامعة الفرات األوسط التقنية‬
‫كلية الصحة والتقنيات الطبية في الكوفة قسم التخدير والعناية المركزة‬

‫مشروع بحوث التخرج بعنوان‪:‬‬

‫مقارنة بين درجتي حرارة مختلفتين من البروبوفول على األلم الذي يسببه البروبوفول أثناء الحقن‬

‫مشروع بحث تخرج‬

‫مقدم إلى مجلس قسم التخدير العناية المركزة‬
‫بكلية التقنيات الصحية والطبية الكوفة جامعة الفرات األوسط التقنية‬
‫في استيفاء جزئي لمتطلبات درجة البكالوريوس في‬
‫تقنيات التخدير والعناية المركزة‬

‫من قبل الطلبة‪:‬‬

‫حسن يوسف حسن‬ ‫مجتبى ثابت مكي‬ ‫منتظر حسين علي‬

‫روان كمال سليم‬ ‫نور الهدى حيدر‬ ‫غادة عبود حمزة‬
‫زينة وناس لويخ‬ ‫زهراء علي يحيى‬ ‫نور الهدى جاسم‬
‫وسن سالم كطيف‬ ‫أوراد راسم فرج‬ ‫رضا علي كاظم‬
‫طيبة حيدر حسين‬ ‫نور طارق حامد‬ ‫زينب علي عباس‬
‫مرتجى رسول حمادي‬ ‫ي خضير‬
‫نورة مح ّ‬ ‫غفران رياض مصطفى‬
‫رانيا احمد حسن‬ ‫زهراء عبد الحسين‬ ‫سارة احمد سلمان‬

‫تحت إشراف‬
‫محمد عبد الزهرة‬
‫ماجستير‪ .‬التخدير والعناية المركزة‬

‫‪ ١٤٤٥‬هجري‬ ‫‪ ٢٠٢٤‬ميَّلدي‬