A Comparative Study of Ketorolac and Lignocaine for Analgesia and Hemodynamic Stability During Propofol-Induced Pain at Anaesthetic Induction
DOI:
https://doi.org/10.36283/ziun-pjmd14-3/029Keywords:
Propofol, Ketorolac, Lignocaine, Anesthesia Induction, Injection Pain, Hemodynamic ResponseAbstract
Background: Pain on injection of propofol is a common and uncomfortable experience during the induction of general anesthesia, often affecting patient satisfaction and comfort. Various pharmacological agents have been explored to reduce this pain, including lignocaine, a local anesthetic, and ketorolac, a non-steroidal anti-inflammatory drug. This study was designed to assess and compare the analgesic and hemodynamic effects of ketorolac versus lignocaine in minimizing propofol-induced pain during general anesthesia induction.
Methods: This randomized comparative study was conducted at the Department of Anaesthesia, Shaikh Zayed Hospital, Lahore, over six months (July 1 to December 31, 2021). A total of 200 patients meeting the inclusion criteria were enrolled after obtaining ethical approval and informed consent. Participants were randomized into two groups: Group A received ketorolac and Group B received lignocaine before propofol injection. Pain scores and hemodynamic responses were recorded and analyzed using SPSS version 21.
Results: The mean age of patients in Group A (ketorolac) was 37.19 ± 8.39 years, and in Group B (lignocaine) was 37.83 ± 8.85 years. The sample included 33.5% males and 66.5% females. Pre-anesthetic pain scores were 2.37 in the ketorolac group and 2.44 in the lignocaine group (p = 0.355). After propofol administration, both groups showed a mean pain score of 0.883 (p = 1.00), indicating no statistically significant difference.
Conclusion: Ketorolac and lignocaine were equally effective in reducing pain associated with propofol injection, with no significant difference in their analgesic or hemodynamic effects during anesthesia induction.
References
1. Janse van Rensburg E, Indiveri L, Mogane P. The perioperative use of dexmedetomidine in paediatric patients. Children. 2025 Jun;12(6):690. https://doi.org/10.3390/children12060690
2. Rauch S, Miller C, Bräuer A, Wallner B, Bock M, Paal P. Perioperative hypothermia—a narrative review. Int J Environ Res Public Health. 2021 Aug;18(16):8749. https://doi.org/10.3390/ijerph18168749
3. Chen Z, Peng T, Zhang S, Yang Q, Qu S, Cao Y, et al. Age-specific plasma concentration, efficacy and safety of ciprofol (cipepofol) for induction and maintenance of general anesthesia in pediatric patients undergoing elective surgery: a single-arm prospective, pragmatic trial. Clin Drug Investig. 2025 Mar;45(3):137–50. https://doi.org/10.1007/s40261-025-01425-y
4. Zhao Y, Qin F, Liu Y, Dai Y, Cen X. The safety of propofol versus sevoflurane for general anesthesia in children: a meta-analysis of randomized controlled trials. Front Surg. 2022 Jul;9:924647. https://doi.org/10.3389/fsurg.2022.924647
5. Singh A, Anjankar AP, Anjankar A. Propofol-related infusion syndrome: a clinical review. Cureus. 2022 Oct;14(10):e30383. https://doi.org/10.7759/cureus.30383
6. Bakhtiari E, Mousavi SH, Gharavi Fard M. Pharmacological control of pain during propofol injection: a systematic review and meta-analysis. Expert Rev Clin Pharmacol. 2021 Jul;14(7):889–99.
7. Bajwa SJS, Vinayagam S, Shinde S, Dalal S, Vennel J, Nanda S. Recent advancements in total intravenous anaesthesia and anaesthetic pharmacology. Indian J Anaesth. 2023 Jan;67(1):56–62. https://doi.org/10.4103/ija.ija_1022_22
8. Chu Y, Sun T, Xie Z, Sun K, Jiang C. Physicochemical characterization and pharmacological evaluation of novel propofol micelles with low-lipid and low-free propofol. Pharmaceutics. 2022 Feb;14(2):414. https://doi.org/10.3390/pharmaceutics14020414
9. Hydrate C, Anesthetics—Amides L, Anesthetics—Esters L, Maxwell L, Suresh S, Tobias JD. Sedatives and analgesics: general principles and pharmacology. In: [Book chapter reference incomplete; needs publisher, place, year, and DOI if available]
10. Patel S, Hughes Driscoll C. Peripheral intravenous catheter–associated injuries in neonates: monitoring, diagnosis, management, and complications. NeoReviews. 2025 Jan;26(1):e28–40. https://doi.org/10.1542/neo.26-1-003
11. Kazi M, Gaskari A, Shahba AA, Ahmad S, Aldughaim MS, Hussain MD. Propofol: current updates, challenges, and strategies for improved self-nanoemulsifying formulation. ACS Pharmacol Transl Sci. 2025 Apr;8(4):1013–27. https://doi.org/10.1021/acsptsci.4c00745
12. Lee GG, Park JS, Kim HS, Yoon DS, Lim JH. Clinical effect of preoperative intravenous non-steroidal anti-inflammatory drugs on relief of postoperative pain in patients after laparoscopic cholecystectomy: intravenous ibuprofen vs. intravenous ketorolac. Ann Hepatobiliary Pancreat Surg. 2022 Sep;26(3):251–6.
13. Gu L, Liu J, Machi AT. Perioperative pain management and enhanced recovery protocols. In: Musculoskeletal Pain. Springer; 2025. p. 467–512. https://doi.org/10.1007/978-3-031-86057-7_22
14. Gaul E, Barbour T, Nowacki AS, Mace SE. Intranasal ketorolac for acute pain in adult emergency department patients. West J Nurs Res. 2022 Nov;44(11):1047–56. https://doi.org/10.1177/01939459211030336
15. Lv ZK, Zhang HT, Cai XJ, Su WX, Zhu EJ, Chong H, et al. Ketorolac in the perioperative management of acute type A aortic dissection: a randomized double-blind placebo-controlled trial. BMC Med. 2025 Jun;23(1):188. https://doi.org/10.1186/s12916-025-04021-1
16. Roshid MHO, Islam MS, Nath RK, Datta PK, Begum SA, Chowdhury GA. A comparative study between intravenous tramadol versus lidocaine pretreatment in reducing pain on propofol injection. J Chittagong Med Coll Teach Assoc. 2021 Dec;32(2):90–4. https://doi.org/10.3329/jcmcta.v32i2.66501
17. Chobpenthai T, Ingviya T, Thanindratarn P, Jaiwithee R, Sutthivaiyakit K. Ketorolac plus lidocaine vs lidocaine for pain relief following core needle soft tissue biopsy: a CONSORT-compliant double-blind randomized controlled study. Medicine (Baltimore). 2021 Feb;100(7):e24721. https://doi.org/10.1097/MD.0000000000024721
18. Niazi ASK, Bajwa MA, Zahra M, Niazi MUK, Zainab I, Anwer A. Efficacy of intra-articular ketorolac and lignocaine on post-operative pain relief after arthroscopic knee surgery. J Ayub Med Coll Abbottabad. 2022 Jun;34(2):273–8. https://doi.org/10.55519/JAMC-02-8647
19. Eskew J, Kelly T, Ode G. Ketorolac as a local analgesic in orthopaedic conditions: a systematic review of safety and efficacy. Curr Orthop Pract. 2023 Jul;34(4):142–59. https://doi.org/10.1097/BCO.0000000000001215
20. Feng W, Wang Y, Ran F, Mao Y, Zhang H, Wang Q, et al. The effectiveness and safety of the rapid titration strategy of background controlled-release oxycodone hydrochloride for patients with moderate-to-severe cancer pain: a retrospective cohort study. Front Med (Lausanne). 2022 Jul;9:918468. https://doi.org/10.3389/fmed.2022.918468
21. Gajniak D, Mendrala K, König-Widuch G, Parzonka S, Gierek D, Krzych ŁJ. Effect of lidocaine on intraoperative blood pressure variability in patients undergoing major vascular surgery. BMC Anesthesiol. 2024 Jun;24(1):170. https://doi.org/10.1186/s12871-024-02550-5
22. Ok E, Barnty B, Eniola J, Enoch O. Adverse effects and safety profiles of propofol and ciprofol: what clinicians should know. [Preprint or journal not specified]; 2024. [DOI and publication details unavailable – please confirm source]
23. Haider SZ, Khoso MA, Ayaz SB, Abbas MA, Rehman HU, Iftikhar H. Pre-treatment with ketorolac alongside venous occlusion can reduce the pain of propofol injection: a quasi-experimental study. Pak Armed Forces Med J. 2022 Apr–Jun;72(2). https://doi.org/10.51253/pafmj.v72i2.7094
24. Ezell J, Tram J, Furnish T. Mechanisms of action of clinically relevant analgesics (non-opiates). In: Mechanisms of Pain. Boca Raton: CRC Press; 2025. p. 230–46.
25. Zahra H, Bary A, Nazeer T, Naseem S, Aziz MA, Hussain R, et al. Comparison of efficacy of ondansetron pre-treatment in alleviating pain due to propofol during general anaesthesia with placebo. Pak J Med Health Sci. 2021 Oct;15:2756–8. https://doi.org/10.53350/pjmhs2115102756
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/
Metrics
How to Cite
