Arm Elevation for Prevention of Propofol Injection Pain

Efficacy of Passive Arm Elevation Versus Lidocaine Pretreatment for Prevention of Propofol Injection Pain: A Randomized, Controlled, Assessor Blinded, Pilot Feasibility Trial

The purpose of this research is to determine whether a simple technique, temporarily raising the arm during the injection of propofol (a commonly used medication for anesthesia), can reduce the pain that some people experience when the medication is given through an IV. The study will compare this technique with the current standard approach of using lidocaine (a numbing medication), as well as a combination of both methods, to determine which approach is most effective at reducing injection pain.

Inclusion Criteria:

• ASA I-III
• 18G or 20G dorsal hand working IV in place (drip by gravity)
• Planned IV propofol infusion with natural airway
• Able to provide consent
• Able to report pain
• English-speaking

Exclusion Criteria:

• Allergy to propofol/lidocaine
• Significant cognitive impairment/acute psychosis
• Any sedative medications given prior to the study
• Pregnancy
• Severe upper-extremity mobility limitation that prevents safe arm elevation
• Emergency medical condition; (e.g. GI bleeding, sepsis, acute heart or respiratory failure)
• Chronic pain syndrome with chronic opioid use
• Any acute pain condition that may be distracting to the patient
• Any report of pain on gravity drip, injection of saline or spontaneous pain when testing the iv in preop prior to bringing the patient to the OR
• Pathology or prior surgery that is deemed to interfere with normal venous drainage of the arm (arterio-venous fistula, history of port or dialysis line, , history of heart failure)
• History of past or current cardiac arrhythmias, cardiac valvular abnormalities, /heart failure, stable angina that are expected to require concomitant administration of vasoactive or inotropic medications with induction
• TIA or stroke within the last 3 months