Introduction: Propofol (2,6 di-isopropyl phenol) is widely used agent for induction of anesthesia, although the pain during its injection remains a concern for all anesthesiologists. The incidence of Propofol injection pain (PIP) varies between 28% to 90% in adults. Despite several interventions and pretreatment with drugs to alleviate pain, the failure rate is 13-32%. The aim of this study was to find the most efficacious method of alleviating PIP by combining  intervention of venous occlusion along with Lignocaine, Dexamethasone or Ondansetron pretreatment.

Methods: This is a double blinded randomized prospective clinical study on adult patients between the age group of 18-59 years scheduled for elective general surgical procedures. 150 patients were randomly allocated through computer generated table into three groups scheduled to receive 2ml of Lignocaine (20mg), Ondansetron (4mg) or Dexamethasone (6mg). Drugs were administered after tourniquet application inflated to 40mm Hg and occlusion was released after 30 seconds and then 0.5mg/kg of propofol was administered at the rate of 0.5ml / sec. The blinded investigator evaluated the pain score using the four point scale at 15 second interval. Statistical analysis was made by SPSS version 16.

Results: The incidence and intensity of pain in patients receiving Lidocaine and Dexamethasone were significantly lower than those receiving Ondansetron (p<0.001).

Conclusion: Pretreatment with intravenous Dexamethasone and Lidocaine along with venous occlusion for 30 seconds was found to be equally effective in reducing Propofol injection pain. Both these drugs were found to be superior to Ondansetron in achieving this goal.