AANA Conference Coverage

Ciprofol Reduces Injection Site Pain Compared With Propofol in Gynecologic Surgery

Miranda Manier, BA

Key Highlights

  • Ciprofol significantly reduced injection site pain compared with propofol in all 6 included randomized controlled trials (RCTs).
  • Only 0.99% of patients receiving ciprofol reported injection pain vs 51.7% of those receiving propofol.
  • Ciprofol was non-inferior to propofol in all studies and had a 100% success rate for induction.
  • Higher patient satisfaction was associated with ciprofol use.

In a review of six randomized controlled trials (RCTs) involving 854 patients undergoing gynecologic surgery, ciprofol was associated with a significantly lower incidence of patient-reported injection site pain compared with propofol. Across all studies, only 0.99% (40/403) of patients receiving ciprofol reported injection site pain, compared with 51.7% (212/410) of those receiving propofol. All included trials demonstrated non-inferiority of ciprofol to propofol for anesthesia induction, with both agents achieving a 100% induction success rate. This study was presented by Cole Givens, BSN, RN, at the American Association of Nurse Anesthesiology 2025 Annual Congress.

Injection pain is a common and distressing side effect of intravenous anesthetics like propofol, reported in 28% to 90% of patients despite mitigation efforts. It is often recalled by patients as a highly unpleasant part of their surgical experience. Propofol-induced injection pain is thought to result from venous irritation and kinin cascade activation. Ciprofol, a propofol analog with a cyclopropyl sidechain, is a newer GABAA receptor agonist with four to six times greater potency. Its lower plasma concentration and higher hydrophobicity may contribute to reduced venous irritation, offering a potential improvement in patient comfort.

This integrative review was conducted to compare patient-reported injection pain between ciprofol and propofol during induction of general anesthesia in adult patients undergoing gynecologic surgery. Researchers searched Embase, CINAHL, and PubMed using terms such as “ciprofol,” “HSK3486,” “gynecologic,” “anesthesia,” and “injection pain.” No date or language limits were applied. The highest level of evidence identified included six RCTs that met inclusion criteria. This quality improvement project was excluded from institutional review board (IRB) approval.

All 6 RCTs used a verbal yes/no rating scale to assess injection pain. The studies included pharmacologic co-induction agents such as midazolam, sufentanil, dexamethasone, flurbiprofen, fentanyl, and alfentanil, but no local anesthetics were administered. Although injection pain was only a primary outcome in one study, each reported significantly reduced pain with ciprofol (range: 0–18.4%) vs propofol (range: 27–76.6%), with p-values consistently less than .001. Three studies also reported statistically significant improvements in patient satisfaction when ciprofol was used.

Limitations included methodological variability across studies, differing co-induction agents, and lack of standardization in primary outcomes. Additionally, existing data are limited to gynecologic surgical patients and international settings, with no US-based RCTs currently available.

As Givens concluded, “Ciprofol can reduce the incidence of patient-experienced injection site pain when compared to propofol in patients undergoing gynecologic procedures.”

Reference:
Givens C. Ciprofol vs propofol on injection site pain in gynecologic surgery. Presented at: American Association of Nurse Anesthesiology (AANA) 2025 Annual Congress; August 9–13, 2025; Nashville, TN. https://www.aana.com/premier-event/annual-congress/