Prevention of Pain on Propofol Injection: A Comparison of Pretreatment with 5-Hydroxytryptamine 3 Antagonists Granisetron, Ondansetron, and Ramosetron

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BACKGROUND AND AIMS: Propofol is commonly used for the induction and maintenance of anesthesia. However, approximately 28%-90% of patients experience pain during injection. In this study, we compared the effectiveness of ondansetron, ramosetron, and granisetron, the three common 5-hydroxytryptamine 3 receptor antagonists in reducing the incidence and severity of propofol-induced pain (PIP). METHODS: This study included 120 adult patients (18-65 years old) scheduled for elective laparoscopic cholecystectomy under general anesthesia. Patients were randomly assigned to four groups ( n = 30 for each group). Granisetron (2 mg) was administered to Group G, ramosetron (0.3 mg) to Group R, ondansetron (4 mg) to Group O, and normal saline to Group N. Venous circulation was occluded by a rubber tourniquet to retain the drug in the vein and prevent its spread in circulation. Pain was assessed at 0, 5, 10, 15, and 20 s using a four-point verbal rating scale (VRS). The Kruskal-Wallis, Chi-square, Friedman tests, and generalized estimating equations were used to analyze the data. RESULTS: Groups O, R, and G demonstrated significantly reduced pain compared to group N at all-time points ( P < 0.001). Granisetron (Group G) was the most effective, with a mean VRS of 0.00 at 20 s. PIP incidence was 100% in Group N, compared to 80%, 70%, and 26.7% in Groups O, R, and G, respectively (χ² =40.443, P < 0.001). CONCLUSION: Granisetron is the most effective in reducing PIP, though ondansetron and ramosetron also offer significant pain relief.

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