Trial reportBMC anesthesiology2026
Dose-dependent effects of esketamine on the prevention of propofol-induced injection pain: a randomized controlled trial.
Trial report in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn our previous study, we showed that a low dose of esketamine could alleviate propofol-induced injection pain during general anesthesia induction. However, the dose-response relationship of esketamine remains unclear. This study aims to evaluate the dose-dependent efficacy of esketamine in preventing propofol-induced injection pain.
methodsIn this double-blind, randomized controlled trial, patients scheduled for elective ear surgery were randomized into five groups: Group NS (normal saline), Group L (40 mg lidocaine), Group S0.075 (0.075 mg/kg esketamine), Group S0.15 (0.15 mg/kg esketamine), and Group S0.3 (0.3 mg/kg esketamine). Study medications were administered intravenously 30 seconds before manual injection of propofol (2 mg/kg). The primary outcome was the incidence of propofol-induced injection pain. Secondary outcomes included the severity of injection pain, hemodynamic changes, and drug-related adverse events.
resultsA total of 171 patients were analyzed. The incidence of propofol-induced injection pain was 71% in the NS group, and significantly decreased to 47%, 29%, and 9% in the S0.075, S0.15, and S0.3 groups, respectively (all P < 0.05). Notably, the S0.3 group demonstrated superior efficacy compared to the lidocaine group (9% versus 32%, P < 0.05). The incidence and pain scores of injection pain were significantly lower in the L, S0.15, and S0.3 groups compared to the NS group (P < 0.05). Moreover, pretreatment with 0.15 and 0.3 mg/kg esketamine was associated with better hemodynamic stability compared to both the NS and lidocaine groups (P < 0.05). Importantly, no statistically significant differences were observed in the incidence of adverse events among all groups.
conclusionsEsketamine pretreatment exhibits dose-dependent efficacy in preventing propofol-induced injection pain, with the 0.3 mg/kg dose providing the most pronounced protective effect. Additionally, both the 0.15 and 0.3 mg/kg doses of esketamine help maintain hemodynamic stability during anesthesia induction. Therefore, 0.3 mg/kg esketamine is recommended as the preferred pretreatment dose, offering effective prevention of propofol-induced pain and stable hemodynamics during induction.
trial registrationChiCTR2100043324. Trial Registration Date: February 10, 2021. Date of enrolment of the first research participant: February 23, 2021.
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