“Comparison of Pre-Treatment with ondansetron Versus Tramadol For Reduction of Pain on Injection of Propofol – A Prospective, Randomized Study”

Background: Propofol, most frequently used intravenous anaesthetic, is used for induction, maintenance of anaesthesia and for sedation in patients scheduled for routine elective surgical procedure. A unique action of propofol is its antiemetic effect, which remain present at concentration less than producing sedation. Pain on injection of propofol still remains a considerable concern for the anaesthesiologist. A number of techniques has been tried to minimize propofol-induced pain with variable results. There are some hypotheses that intravenous administration of ondansetron might decrease propofol injection induced pain. Moreover, some studies have shown that pretreating the vein with i.v. tramadol has proved to be effective in preventing propofol injection pain in adults. In the present prospective randomized study, we compared pretreatment with ondansetron versus tramadol for prevention of propofol injection pain. Materials and Methods: A total of 60 patients were taken up in the study in the age group of 18 to 60 years of either sex, ASA grade I/II, scheduled for routine elective surgical procedure under general anesthesia with endotracheal intubation. The patients enrolled were divided randomly into three groups of 20 patients each. Group I received 2 ml of ondansetron intravenous (2 mg/ml). Group II received 2 ml of 50 mg tramadol intravenous in saline. Group III received 2 ml of 0.9% normal saline intravenous. The patients were asked to report their pain according to the scale provided to them in the form of none, mild, moderate, and severe (verbal rating scale). Statistical testing was conducted with the statistical package for the social science (SPSS) for Windows. For all statistical tests, p<0.05 was taken to indicate a significant difference. Results: Mean age of patients in Group I was 37.6 years, in Group II was 40.75 years and in Group III was 40.45 years. All mean ages were comparable. Also, patients of both the sexes were equally distributed in three groups. As per McCririck and Hunter scale, no pain was reported by 75%, 85% and 20% patients in i.v. ondansetron, i.v. tramadol and i.v. normal saline groups respectively. Mild pain was reported by 25%, 15% and 45% patients in i.v. ondansetron, i.v. tramadol and i.v. normal saline groups respectively. No patients in i.v. ondansetron and i.v. tramadol drug groups reported moderate or severe pain, whereas 15% and 20% respectively reported moderate and severe pain in i.v. normal saline group. Statistically significant difference is observed when i.v. ondansetron drug group is compared with i.v. normal saline group (p=0.001), as well as when i.v. tramadol drug group is compared with i.v. normal saline group (p=0.000). Conclusion: Intravenous ondansetron is equally effective and can be used alternatively to injection tramadol for relief of pain due to propofol injection without any significant side effects.