OBJECTIVE Pain on injection is a well known adverse effect of propofol. The purpose of this study was to compare the analgesic effect of a lidocaine (lignocaine)/remifentanil combination compared with either lidocaine alone or remifentanil alone during propofol injection for induction of anaesthesia. METHODS In a randomised, double-blind, prospective trial, 129 patients were allocated to one of three groups (each n = 43) receiving lidocaine 20mg, remifentanil 0.3 microg/kg or lidocaine 20 mg plus remifentanil 0.3 microg/kg as pretreatment, followed by injection of 5 mL of 1% propofol. Pain severity was evaluated on a four-point scale. RESULTS Two patients (4.7%) complained of pain in the lidocaine plus remifentanil group compared with 15 (35.7%) in the lidocaine alone group and 18 (42.9%) in the remifentanil alone group (p < 0.001). There was no significant difference in the incidence of injection pain between the lidocaine alone and remifentanil alone groups (p = 0.21). CONCLUSIONS Pretreatment with a combination of lidocaine and remifentanil is more effective than either pretreatment alone in reducing pain on injection of propofol.