Incidence of injection pain between ciprofol and propofol after induction of general anesthesia: a systematic review and meta-analysis of randomized controlled trials

Front Med (Lausanne). 2026 Feb 3;13:1749156. doi: 10.3389/fmed.2026.1749156. eCollection 2026.

ABSTRACT

BACKGROUND: Propofol and ciprofol are commonly used agents for inducing general anesthesia. Although propofol is preferred for its potent sedative effects and quick recovery, it is associated with a higher incidence of injection-related pain. In contrast, ciprofol may help alleviate this pain. However, evidence regarding its advantage in reducing injection pain remains insufficient. This systematic review aimed to assess the frequency of pain during administration tied to the use of ciprofol as well as propofol.

METHODS: A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify randomized controlled trials comparing ciprofol with propofol for the induction of general anesthesia. Two reviewers independently screened studies and extracted data. Meta-analyses were performed using Review Manager software.

RESULTS: Ten trials with a total of 1,402 patients were studied in this meta-analysis. Research results showed that ciprofol markedly reduced the occurrence of pain from injections when contrasted with propofol, exhibiting a risk ratio (RR) of 0.15 (95% confidence interval [CI]: 0.11 to 0.20). Ciprofol significantly reduced the incidence of injection pain when the patient was elderly (RR = 0.14, 95% CI: 0.06 to 0.35), and also non-elderly (RR = 0.15, 95% CI: 0.11 to 0.21). In addition, ciprofol significantly reduced the incidence hypotension (RR = 0.63, 95% CI: 0.46 to 0.87). A trend toward lower tachycardia was observed with ciprofol, but this did not reach statistical significance (RR = 0.63, 95% CI 0.39-1.01). The GRADE assessment revealed moderate certainty regarding the outcomes associated with injection pain. Trial sequential analysis (TSA) suggested that the cumulative evidence for injection pain and hypotension was sufficient and that further trials are unlikely to change these conclusions.

CONCLUSION: The study revealed that ciprofol significantly decreases the occurrence of injection-related discomfort and was associated with a reduced incidence of hypotension, while a trend toward lower tachycardia was observed. Trial sequential analysis further supported the robustness of these findings.

SYSTEMATIC REVIEW REGISTRATION: CRD420251003081.

PMID:41709903 | PMC:PMC12909516 | DOI:10.3389/fmed.2026.1749156