• Seong Heon Lee, Soo Eun Lee, Shiyoung Chung, Hyun Jung Lee, and Seongwook Jeong.
• Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, South Korea.
• J Clin Anesth. 2016 Nov 1; 34: 510-5.

Study ObjectiveTo determine the most effective time interval between remifentanil and propofol (TimeRP) for the prevention of propofol injection pain in association with remifentanil dosage.DesignProspective randomized study.SettingOperating room of a university hospital.PatientsSixty American Society of Anesthesiologists physical status 1 and 2 patients scheduled for elective surgery under general anesthesia.InterventionsPatients were randomly assigned to 1 of 3 groups to receive remifentanil at dosages of 0.25, 0.5, or 0.75 μg/kg over 30 seconds before the injection of 1% propofol 2 mg/kg. TimeRP was defined as the time interval from the initiation of the remifentanil injection to the initiation of the propofol injection. TimeRP for each subsequent patient was determined by the response of the previous patient using an up-and-down sequential allocation method. Injection pain caused by propofol was evaluated using a 4-point scale during the propofol injection.MeasurementsTimeRP50 was defined as the TimeRP at which propofol injection pain was absent in 50% of patients, and it was estimated using isotonic regression for each dose group.Main ResultsTimeRP50 was significantly lower in the remifentanil 0.75 μg/kg group (38.6 seconds, 83% confidence interval [CI], 35.6-45.0) than in the 0.5 μg/kg group (65.0 seconds; 83% CI, 52.5-75.0) or the 0.25 μg/kg group (66.6 seconds; 83% CI, 57.1-76.5).ConclusionsThe efficacy of remifentanil pretreatment for preventing propofol injection pain can be influenced by the time interval between remifentanil and propofol as well as the remifentanil dose.Copyright © 2016 Elsevier Inc. All rights reserved.

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