Pain on Injection of Rocuronium Bromide

et al. 2011

BackgroundThe aim of this study was to evaluate whether slow injection of diluted rocuronium could reduce rocuronium-induced withdrawal movements effectively in children.MethodsAfter loss of consciousness, rocuronium 0.6 mg/kg was administered into 171 children according to the pre-assigned groups as follows: Group CF, injection of non-diluted rocuronium over 5 seconds; Group CS, injection of non-diluted rocuronium over 1 minute; Group DF, injection of diluted rocuronium (10 times) over 5 seconds; Group DS, injection of diluted rocuronium over 1 minute. An investigator who was blind to the injection techniques recorded patient movements followed by rocuronium injection.ResultsThe incidence of withdrawal movement in Group CF was highest among the groups (all P < 0.0001). Moreover, withdrawal movement was less frequently observed in Group DS than in Groups CS and DF (P = 0.021 and P = 0.007, respectively).ConclusionsSlow injection of diluted rocuronium reduced the incidence of withdrawal movements in children.

Section: Discussioncontrasting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Dilution and slow injection reduces the incidence of rocuronium-induced withdrawal movements in children

Shin

Kim

et al. 2011

“…Intravenously injected rocuronium causes burning pain in approximately 50-80% of patients and the pain continues for approximately 10-20 seconds immediately after the injection [3,4]. The precise mechanism for this pain has not yet been elucidated and only a few hypotheses exist.…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been reported that 50-80% of patients who receive rocuronium complain of burning intravenous injection pain and show withdrawal movement in their arm or whole body [3,4]. This pain-induced withdrawal reflex can dislodge the intravenous catheter and make it difficult to inject the medication.…”

Section: Introductionmentioning

confidence: 99%

Effect of pretreatment with palonosetron on withdrawal movement associated with rocuronium injection

Cho

et al. 2014

BackgroundThe main disadvantage of rocuronium is the pain associated with vascular injection. We evaluated the efficacy of palonosetron for reducing pain after rocuronium injection.MethodsEighty patients scheduled for elective surgery were randomly divided into two groups: Group C (normal saline 1.5 ml, n = 40) and Group P (palonosetron 0.075 mg, n = 40). Anesthesia was induced with thiopental 5 mg/kg and the test drug was injected over 10 seconds. Thirty seconds after the injection of the test drug, rocuronium 0.6 mg/kg was injected over 30 seconds and the response was recorded. Injection pain was graded using a 4-point scale. The grade was 0 points for no movement, 1 point for wrist movement, 2 points for elbow or shoulder movement, and 3 points for whole body movement. Mean arterial pressure and heart rate were recorded on arrival in the operating room and before and 30 seconds after rocuronim injection.ResultsThere was no significant difference in the grade 1 response between the two groups; however, the grade 2 and 3 responses in Group P were 5 (12.5%) and 4 (10%), respectively, which were significantly lower than in Group C, with 13 (32.5%) responses for each grade. There were no significant differences in hemodynamic changes within each group. However, the difference in mean arterial pressure before and after the injection of rocuronium was significantly larger in Group C compared to Group P.ConclusionsPretreatment with palonosetron 0.075 mg reduced the incidence and severity of withdrawal movement after rocuronium administration.

“…However, it is often associated with injection pain, the cause of which is unclear. A number of studies have reported rocuronium injection pain, with an incidence of up to 80% [2,3,4]. Rocuronium injection pain can appear as a withdrawal movement of patients during induction of general anesthesia [5].…”

Section: Introductionmentioning

confidence: 99%

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

Choi

et al. 2014

BackgroundWe purposed to systemically review studies investigating the prophylactic effect of both pharmacological and non-pharmacological modalities against rocuronium induced withdrawal movement (RIWM) in the Korean population.MethodsLiterature search was performed using MEDLINE, EMBASE, CENTRAL, Koreamed, KMBASE, KISS and RISS up to March 2014. Randomized controlled trials (RCTs) comparing pharmacological and non-pharmacological interventions with placebo aimed for the Korean population were included. Outcome measures were the incidence and severity of RIWM. We conducted subgroup analyses according to each intervention method.ResultsData were analyzed from 41 RCTs totaling 4,742 subjects. The overall incidence of RIWM was about 80% (range 56-100%). Incidence and severity of RIWM were significantly reduced with lidocaine (risk ratio [RR] 0.60, 95% CI 0.49-0.74; standardized mean difference [SMD] -0.74, 95% CI -1.05 to -0.44), opioids (RR 0.28, 95% CI 0.18-0.44; SMD -1.71, 95% CI -2.09 to -1.34) and hypnotics (RR 0.36, 95% CI 0.25-0.52; SMD -2.20, 95% CI -2.62 to -1.79). Regardless of tourniquet use, lidocaine showed a prophylactic effect against incidence and severity of RIWM: tourniquet (RR 0.36, 95% CI 0.21-0.62; SMD -1.51, 95% CI -2.15 to -0.86); non-tourniquet (RR 0.58, 95% CI 0.47-0.71; SMD -0.74, 95% CI -1.05 to -0.44). Dilution and slow injection of rocuronium decreased incidence and severity of RIWM: dilution (RR 0.47, 95% CI 0.39-0.56; SMD -1.64, 95% CI -2.47 to -0.81); slow injection (RR 0.34, 95% CI 0.17-0.70; SMD -2.13, 95% CI -2.74 to -1.51).ConclusionsThe greater part of pharmacological and non-pharmacological interventions showed prophylactic effect against the incidence and severity of RIWM in the Korean population.