Pain during injection occurs all except

Induction of anesthesia with propofol is often associated with pain on injection, apnea, hypotension, and, rarely, thrombophlebitis of the vein into which propofol is injected.Pain on injection is reduced by using a large vein, avoiding veins in the dorsum of the hand, and adding lidocaine to the propofol solution or changing the propofol formulation. Multiple other drugs and distraction techniques have been investigated to reduce the pain on injection of propofol. Pretreatment with a small dose of propofol, opiates, nonsteroidal antiinflammatory drugs, ketamine, esmolol or metoprolol, magnesium, a flash of light, a clonidine-ephedrine combination, dexamethasone, and metoclopramide all have been tested with variable efficacy. Ketamine has been administered by the IV, intramuscular (IM), transcutaneous, oral, nasal, and rectal routes and as a preservative-free solution epidurally or intrathecally. Most clinical use involves the IV and IM routes, by which the drug rapidly achieves therapeutic concentrations. The dose depends on the desired therapeutic effect and on the route of administration. There is no pain on injection. Although etomidate provides stable hemodynamics and minimal respiratory depression, it is associated with several adverse effects when it is used for induction, including nausea and vomiting, pain on injection, myoclonic movement, and hiccups. Etomidate has been associated with PONV. More recently, etomidate in a lipid emulsion was associated with equal or an increased incidence of postoperative nausea compared with propofol. The lipid formulation of etomidate is associated with a much less frequent incidence of pain on injection, thrombophlebitis, and histamine release. Pain on injection may be reduced by injecting IV lidocaine, 20 to 40 mg immediately before injection of etomidate. Ref: Millers anesthesia 8th edition