Comparison of Attenuation of Propofol-Induced Pain Using Xylocaine vs Ondansetron in Patients Undergoing General Anesthesia

Ahad Ali Khan; Muhammad Javed; Muhammad Daud Ahmad; Mahnoor Rafique Butt

doi:10.54112/bcsrj.v7i6.2303

Authors

Ahad Ali Khan Department of Anesthesia, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
Muhammad Javed Department of Anesthesia, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
Muhammad Daud Ahmad Department of Anesthesia, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan
Mahnoor Rafique Butt Department of Anesthesia, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i6.2303

Keywords:

General anaesthesia; injection pain; lidocaine; ondansetron; propofol

Abstract

Pain during intravenous propofol administration is a common and distressing adverse effect of anaesthetic induction. Lidocaine and ondansetron have both been used to reduce this pain, although their comparative effectiveness remains uncertain. Objective: To compare the effectiveness of intravenous lidocaine and ondansetron in reducing the incidence and severity of propofol-induced injection pain in patients undergoing general anaesthesia. Methods: This prospective, double-blind, randomized controlled trial was conducted at the Department of Anaesthesiology, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan, from September 2025 to February 2026. A total of 120 patients aged 18–60 years with American Society of Anesthesiologists physical status I or II were randomly allocated to receive either intravenous lidocaine 40 mg (Group L, n = 60) or ondansetron 4 mg (Group O, n = 60) under venous occlusion before propofol administration. Propofol-induced pain was evaluated using the four-point McCrirrick and Hunter pain scale. Data were analysed using the independent-samples t-test, chi-square test, or Fisher's exact test, as appropriate. A p-value <0.05 was considered statistically significant. Results: Baseline demographic and clinical characteristics were comparable between the two groups. Propofol-induced injection pain occurred in 11 patients (18.3%) in the lidocaine group and 23 patients (38.3%) in the ondansetron group (p = 0.016). Lidocaine produced a 52% relative reduction in the risk of injection pain compared with ondansetron (relative risk: 0.48; 95% confidence interval: 0.26–0.89). The overall distribution of pain severity differed significantly between the groups (p = 0.024). Moderate-to-severe pain occurred in 4 patients (6.7%) receiving lidocaine compared with 14 patients (23.3%) receiving ondansetron. Conclusion: Intravenous lidocaine was more effective than ondansetron in reducing both the incidence and severity of propofol-induced injection pain. Lidocaine may therefore be preferred as a simple, accessible, and cost-effective pretreatment before propofol administration.

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