PAIN ON I.V. INJECTION OF SOME ANAESTHETIC AGENTS IS EVOKED BY THE UNPHYSIOLOGICAL OSMOLALITY OR pH OF THEIR FORMULATIONS

Klement, W.; Arndt, J. O.

doi:10.1093/bja/66.2.189

Cited by 202 publications

(107 citation statements)

References 8 publications

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“…Unphysiological osmolality or pH-induced nociceptor activation, and release of endogen mediators such as histamine and bradykinin can be mentioned among the causes of this side effect (10). The onset of pain immediately after injection and pain limited to the arm where rocuronium is injected suggests that the drug induces pain via direct irritation of peripheral veins (11)(12)(13). Administration of various different drugs such as local anaesthetics, opioids, sodium bicarbonate and ondansetron, at the same time or before rocuronium administration have been tried in the attempts to prevent injection pain (4, 14-16).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

Erbabacan¹,

Köksal²,

Tütüncü³

et al. 2013

Turk J Anesth Reanim

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Objective: We aimed to evaluate Visual-Analogue-Scale (VAS) scores, hand-withdrawal, rash and skin eruptions after injections of different concentrations of rocuronium in intubation doses in alert patients using the isolated-forearm technique.Methods: Eighty ASA I-II patients were included in a randomized, controlled, single-blinded study. Two 20 G cannulas were inserted into the dorsum of the left and right hand in each patient. A tourniquet was applied to the left arm and inflated to 50 mm Hg above the patient's systolic blood pressure. Group 1 (n=20) received 2.5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received 10 mg mL -1 rocuronium and 0.4 mg mL -1 lidocaine mixture, and Group 4 (n=20) received 10 mg mL -1 rocuronium via a cannula on the left hand, provided that a dose of 0.6 mg mL -1 were given to all groups of patients. VAS 0 -VAS 60 values, hand-withdrawal, rash and skin eruptions were assessed in patients who were administered rocuronium but not under the effects of hypnotic or neuromuscular agents. Hemodynamic values were recorded both before and after the administration of hypnotic-neuromuscular agents.Results: VAS0 values were significantly higher in Group 4 when compared to Groups 1, 2 and 3 (p=0.032). No significant difference was observed between VAS0 and VAS60 values in Groups 1, 2 and 3. In Group 4, VAS 0 values were significantly higher than VAS 60 values (p=0.003). No significant difference was observed between groups in terms of side effects and hemodynamic values. Conclusion:In conclusion, we determined that using rocuronium diluted with 0.9% NaCl was more effective in preventing injection pain than using a rocuronium-lidocaine mixture.Key Words: Rocuronium, intravenous injection, pain AbstractThe patient was transferred to the operating room, and two 20-gauge cannulas were placed at the back of the patient's right and left hands at one attempt without causing any hematoma and 4 mL kg -1 of 0.9% NaCl infusion was started from the right hand. Age, weight and gender of the patients were recorded, and as a standard procedure ECG, SpO 2 , non-invasive arterial pressure monitoring was performed (Datex Ohmeda S/5 Avance) in the operating room. Patients were randomized into 4 groups. Group 1 (n=20) received 2.5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 2 (n=20) received 5 mg mL -1 rocuronium diluted with 0.9% NaCl, Group 3 (n=20) received a mixture of 10 mg mL -1 rocuronium and 0.4 mg mL -1 lidocaine, and Group 4 (n=20) received 10 mg mL -1 rocuronium, providing a total dose of 0.6 mg kg -1 in all groups. No analgesics were administered before rocuronium application. Drugs were prepared in 20 mL syringes by an anaesthetist other than the anaesthetist who would administer the drug. In order to provide double blind testing, the syringes were covered with a non-transparent foil in order to keep the anaesthetist who administered the drug, unaware about the concentration and content of the drug.In order to p...

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Section: Discussionmentioning

confidence: 99%

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

Erbabacan¹,

Köksal²,

Tütüncü³

et al. 2013

Turk J Anesth Reanim

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“…Rokuronyum enjeksiyon ağrısının patofizyolojisindeki diğer mekanizmalar arasında; doğrudan venöz nosiseptörleri irrite eden kinin gibi lokal mediatörlerin salın-ması ve C nosiseptörlerini doğrudan aktive edebilen aminosteroidal nöromusküler blokörlerin allojenik etkisi sayılabilir. [17][18][19][20][21] Literatürde rokuronyum enjeksiyon hızının ve veriliş şeklinin enjeksiyon ağrısına ve geri çekme hareketine etkisi olduğunu gösteren çalışmalar mevcuttur. Lee ve ark.…”

Section: Tablo 2 Grupların çEkme Yanıt Skoru Dağılımıunclassified

The effect of Rocuronium Administration Rate And Remifentanil on The Prevention of Rocuronium Injection Pain in Pediatric Cases

Güneş²,

Ilgınel³

et al. 2017

Agri

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ÖzetAmaç: Bu çalışmada genel anestezi alması planlanan pediatrik olgularda yavaş ve hızlı rokuronyum enjeksiyonu öncesi uygulanan remifentanilin, hemodinamik değişiklikler ve rokuronyum enjeksiyon ağrısı üzerine olan etkisini belirlemeyi hedefledik. Gereç ve Yöntem: Çalışmamıza 5-15 yaş arasında, ASA I-II grubu 120 pediatrik hasta alındı. Birinci gruba (Grup A) rokuronyum yavaş enjeksiyonundan önce 4ml salin, ikinci gruba (Grup B) rokuronyum yavaş enjeksiyonundan önce 0,5µg kg-1 remifentanil, üçüncü gruba (Grup C) rokuronyum hızlı enjeksiyonundan önce 4ml salin, dördüncü gruba (Grup D) rokuronyum hızlı enjeksiyonundan önce 0,5µg kg-1 remifentanil verildi. Rokuronyum enjeksiyonu sırasında hastaların çekme yanıtları 0-3 puanlı çekme yanıt skoruna göre kaydedildi. Hemodinamik parametreler kaydedildi. Bulgular: Remifentanil yapılan gruplarda rokuronyum enjeksiyonu sonrası 1. dk' da plasebo yapılan gruplara göre kalp atım hızı ölçümleri daha düşük bulundu. Hastaların çekme yanıt skorları incelendiğinde yanıtsızlık oranının en yüksek olduğu gruplar B (%66.7) ve D grupları ( %70) idi. Yanıt olmayan hasta sayısı salin uygulanan A ve C gruplarında 9 iken, remifentanil uygulanan B grubunda 20, D grubunda 21 idi. Jeneralize yanıt ise en çok ( %20) A ve C gruplarında görüldü. Sonuç: Pediyatrik olgularda rokuronyuma bağlı gelişen enjeksiyon ağrısında enjeksiyon hızının etkisinin olmadığı, rokuronyum öncesi yapılan remifentanilin ciddi hemodinamik değişikliklere yol açmaksızın enjeksiyon ağrısını enjeksiyon hızı ile ilişki-siz olarak önemli oranda azalttığı kanısına varıldı.

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“…Mechanisms proposed include the activation of nociceptors by acidic sensing ion channels (Klement and Arndt, 1991) or by an indirect action via the plasma kallikrein-kinin system (Scott et al, 1988). Recent reports suggest a major role for transient receptor potential (TRP) ion channels, especially TRPA1 (Matta et al, 2008;Lee et al, 2008).…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Propofol decreases the axonal excitability in rat primary sensory afferents

et al. 2012

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AIMS: The aim of this present study was to investigate the changes of peripheral sensory nerve excitability produced by propofol. MAIN METHODS: In a recently described in vitro model of rodent saphenous nerve we used the technique of threshold tracking (QTRAC®) to measure changes of axonal nerve excitability of A -fibres caused by propofol. Concentrations of 10 Mol, 100 Mol and 1000 Mol were tested. Latency, peak response, strength-duration time constant ( SD) and recovery cycle of the sensory neuronal action potential (SNAP) were recorded. KEY FINDINGS: Our results have shown that propofol decreases nerve excitability of rat primary sensory afferents in vitro. Latency increased with increasing concentrations (0 Mol: 0.96±0.07ms; 1000 Mol 1.10±0.06ms, P<0.01). Also, propofol prolonged the relative refractory period (0 Mol: 1.79±1.13ms; 100 Mol: 2.53±1.38ms, P<0.01), and reduced superexcitability (0 Mol: -14.0±4.0%; 100 Mol: -9.5±5.5%) and subexcitability (0 Mol: 7.5±1.2%; 1000 Mol: 3.6±1.2) significantly during the recovery cycle (P<0.01). SIGNIFICANCE: Our results have shown that propofol decreases nerve excitability of primary sensory afferents. The technique of threshold tracking revealed that axonal voltage-gated ion channels are significantly affected by propofol and therefore might be at least partially responsible for earlier described analgesic effects. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTThe aim of this present study was to investigate the changes of peripheral sensory nerve excitability produced by propofol.Main methods: In a recently described in vitro model of rodent saphenous nerve we used the technique of threshold tracking (QTRAC ® ) to measure changes of axonal nerve excitability of Aβ-fibres caused by propofol. Concentrations of 10 μMol, 100 μMol and 1000 μMol were tested. Latency, peak response, strength-duration time constant (τSD) and recovery cycle of the sensory neuronal action potential (SNAP) were recorded.Key findings: Our results have shown that propofol decreases nerve excitability of rat primary sensory afferents in vitro. Latency increased with increasing concentrations (0 µMol: 0.96 ± 0.07 ms; 1000 µMol 1.10 ± 0.06 ms, P<0.01). Also, propofol prolonged the relative refractory period (0 µMol: 1.79 ± 1.13 ms; 100 µMol: 2.53 ± 1.38 ms, P<0.01), and reduced superexcitability (0 µMol: -14.0 ± 4.0%; 100 µMol: -9.5 ± 5.5 %) and subexcitability (0 µMol: 7.5 ± 1.2 %; 1000 µMol: 3.6 ± 1.2) significantly during the recovery cycle (P<0.01).Significance: Our results have shown that propofol decreases nerve exc...

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PAIN ON I.V. INJECTION OF SOME ANAESTHETIC AGENTS IS EVOKED BY THE UNPHYSIOLOGICAL OSMOLALITY OR pH OF THEIR FORMULATIONS

Cited by 202 publications

References 8 publications

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

Comparison of the Effect of Different Concentrations of Rocuronium on Injection Pain and Haemodynamics Using Isolated Forearm Technique

The effect of Rocuronium Administration Rate And Remifentanil on The Prevention of Rocuronium Injection Pain in Pediatric Cases

Propofol decreases the axonal excitability in rat primary sensory afferents

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