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Tuesday, September 23, 2014
Burning Sensation Anesthetic Administration
Hello, I just came out of day surgery, `Medial Branch Block`. When they put the 3 test needles into my spine (beside) I would have rated the pain at least 8/10, but it was relatively quick and just barable. When it came time to actually burn the nerves, the anethetist said it was time to put me under for 15 mins. Well as soon as she started pushing the drug into the pre set caferta(excuse my spelling). It felt like my hand had petrol poured on it and was set alight, I was screaming, "My hand, my hand!" It only lasted as long as it took for the anesthetic to work, but the pain I experienced was violent, excruciatating. I need to have this proceedure again possible 2 or 3 more times, now the thought scares the `....` out of me. Can some one explain this to me? Kindest Regards
The drug that the anesthetist or anesthesiologist injected into your intravenous (IV) catheter was propofol (original trade name Diprivan). Around the world this is the most commonly used IV anesthetic. Propofol has been in use for more than 25 years. When administered by suitably trained individuals with appropriate monitoring it is safe, effective and relatively free of side-effects. One of the side-effects that propofol does have unfortunately is pain on injection. This is very common but not usually as severe as you experienced. Fortunately it is short lived - you quickly become unconscious as the drug takes effect. And although uncomfortable there is no injury to the tissues or permanent harm of any sort.
There are various strategies for reducing the pain on injection that occurs with propofol. The local anesthetic lidocaine is often added to the syringe of propofol, but this is less effective than injecting a small dose of lidocaine into the IV catheter, allowing the drug to "sit" there for a few moments before injecting the propofol.
Another method is to administer other sedatives or anesthetic agents before the propofol.
Finally, it is possible to avoid propofol entirely and to administer sedation and anesthesia with other drugs. This is not usually necessary and propofol is by far the preferred drug for these purposes today.
Recently a new formulation of propofol, known as fospropofol, has been marketed. This drug has very much less pain on injection. However it is not yet widely used, one reason being its higher cost.
If you inform your anesthesiologist about your previous experience it is likely that a way will be found to reduce the discomfort
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University