Optimal dose of methylprednisolone for reduction of propofol injection pain: A randomized, double-blind, placebo controlled study

Introduction and Aims: Propofol (2,6-di-isopropylphenol) used for the induction of anaesthesia often causes mild to severe pain on injection, for which various methods have been tried, but with conflicting results. We designed a placebo-controlled, double-blind study to compare the efficacy of different doses of intravenous methylprednisolone for attenuation of propofol injection pain. Materials and Methods: One hundred twenty adult patients belonging to the American Society of Anaesthesiologists (ASA) physical Status II and III, between 21 and 60 years, scheduled for elective cardiac surgery, were divided into four groups: saline (group S, n=30), methylprednisolone 40mg (Group methylprednisolone 1 MP1, n=30), methylprednisolone 125mg (group methylprednisolone 2 MP2, n=30) and methylprednisolone 250mg (Group methylprednisolone 3 MP3, n=30) diluted into 2ml of distilled water. Study drugs were administered after tourniquet application and occlusion was released after 1 min and 1/4th of the total dose of propofol (2mg/kg) was administered at the rate of 0.5ml per second. Pain on propofol injection was assessed by four-point verbal rating scale. Statistical methods used included Chi-square test/Fisher's exact test and Student's t-test. Results: Demographic variables were similar among all the groups. The overall incidence of pain was 70% in the saline group, 53.33% in MP1 and 33.33% in both MP2 & MP3. Pain intensity was significantly less in patients receiving MP2 & MP3 drugs for pre-treatment than those receiving saline (P<0> Conclusions: Pre-treatment with either 125mg or 250mg intravenous methylprednisolone was found to be effective in reducing propofol injection-induced pain. But pre-treatment with 250 mg MP itself was associated with pain during injection.