Propofol injection pain: a study of more than 1,300 patients shows how many remember the burning after anesthesia and which measures reduce it.
What is propofol injection pain?
Propofol is the drug most commonly used to put patients to sleep at the start of general anesthesia and for sedation during tests and minor procedures. It is the white, milk-like liquid that the anesthesiologist injects into a vein a few seconds before the patient falls asleep. In exactly those seconds, many patients feel a burning sensation along the arm: this is propofol injection pain, one of the most common and best-known side effects in anesthesia.
Why remembering the propofol burn is a potentially unpleasant experience
The burning lasts a few seconds and disappears as the patient falls asleep. The real question, then, is not whether propofol burns, but whether the patient remembers it afterwards. The memory is what remains of the experience of anesthesia, and it can influence the fear of the next operation. Until now we knew little about how many patients keep this memory and what makes it more likely: this study fills exactly that gap.
A bit of history: when did propofol come into use?
Propofol entered clinical practice in the 1980s and within a few years replaced most of the earlier drugs, because it allows a quick, clean awakening with little nausea. The burning on injection has been described since the beginning of its use, so it is not related to the excipients but to the active ingredient itself. The reason is that the drug irritates the wall of small veins, and for this reason anesthesiologists have developed several measures over time to reduce it, from using larger veins to giving other drugs before induction, such as adding a little local anesthetic to numb the vein wall during the injection.
How the study on propofol and injection pain was conducted
In a single hospital, 1,699 English-speaking adults receiving propofol, under general anesthesia or monitored sedation, were enrolled. During induction, the researchers recorded patient characteristics, the site of venous access, the drugs used and the pain observed by the anesthesiologist. The day after surgery, patients were interviewed with a standard questionnaire to find out whether they remembered discomfort during the injection. 1,319 patients completed the interview.
The results: propofol and memory of the burning
About one patient in twelve, 8%, remembered the discomfort of the injection the next day. Four factors were linked to more frequent recall:
younger age: each year of younger age slightly increases the probability of recall (odds ratio 1.03 per year);
female sex: odds ratio 1.69;
venous access on the hand rather than at sites with larger veins: odds ratio 2.16;
no premedication with midazolam, the sedative often given before induction: odds ratio 2.62.
The last two factors are the most interesting, because they depend on the anesthesiologist's choices and can therefore be changed.
What it means for the patient
Propofol injection pain is unpleasant but harmless, and in the vast majority of cases it leaves no memory at all. In clinical practice I have noticed that explaining it beforehand, with a simple sentence ("you will feel a little burning in your arm, then you will fall asleep"), is enough to remove most of the surprise and fear. Anyone with a bad memory of a previous anesthesia does well to mention it during the pre-anesthesia assessment: it is useful information for the anesthesiologist, who can choose a larger vein, add a local anesthetic directly to the propofol to reduce injection pain, or use midazolam premedication, which reduces anxiety and the non-somatic component of pain.
What it means for the physician
The study shifts the focus from observed pain to the memory reported by the patient, which the authors propose as a clinical outcome in its own right, centred on the patient.
The two modifiable factors are concrete: avoid hand veins for induction whenever possible and consider midazolam premedication in younger patients and in women, who remember more often. It should also be considered, however, that in practice a vein on the hand is often the simplest option for the anesthesiologist and the one with the lowest risk of error, so explaining this to the patient can also help make a more informed choice about which solution is best.
Midazolam should in any case be dosed with caution in older people and in those with breathing problems, because it increases sedation.
The benefit is small for the individual patient, but over thousands of inductions a year the number of bad memories avoided becomes large.
References
Mai D, Rowshan K, Modha D, Chiou K, et al. Propofol injection discomfort recall after monitored anesthesia care or general anesthesia: a prospective observational cohort study. Journal of Anesthesia. 2026. doi:10.1007/s00540-026-03926-2. PubMed
Dr. Marco De Nardin
Medical Doctor, Specialist in Anesthesiology, Intensive Care and Pain Management
Dr. Marco De Nardin is a physician specializing in Anesthesiology, Intensive Care, and Pain Management. He completed his medical degree and specialty training in Italy, where he continues to practice at his private clinics in Mestre (Venice) and Milan. With extensive clinical experience spanning operating rooms, intensive care units, and pain management clinics, Dr. De Nardin brings a unique perspective that bridges acute-care medicine with chronic disease management. His clinical practice focuses on regional anesthesia, ozone therapy, intravenous infusion therapy, and integrative approaches to pain treatment. He is the founder of Med4Care, a medical information platform delivering evidence-based, physician-reviewed health content. Every article published under his name reflects his commitment to making complex medical topics accessible to patients without compromising scientific rigor.
