Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults

Prabhakar, Hemanshu; Singh, Gyaninder Pal; Ali, Zulfiqar; Kalaivani, Mani; Smith, Martha Amy

doi:10.1002/14651858.cd009346.pub2

Cited by 8 publications

(4 citation statements)

References 80 publications

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“… 23 Nalbuphine provided good analgesia of adequate duration and proved to be an acceptable alternative to lidocaine. 24 The pros and cons of the results indicate that nalbuphine might be more suitable for pretreatment due to reduced pain during intravenous injection.…”

Section: Discussionmentioning

confidence: 98%

Effect of nalbuphine on rocuronium injection pain

Huang

Wang

et al. 2021

World Jnl Ped Surgery

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ObjectiveRocuronium-associated intravenous injection pain occurs frequently in children during induction of anesthesia. The aim of this study was to systematically evaluate the benefits of nalbuphine in patients with rocuronium-associated injection pain.MethodsNinety children undergoing tonsillectomy and adenoidectomy in our hospital between October 2019 and September 2020 were randomly divided into the following groups, with 30 patients per group: control group (group C), lidocaine group (group L), and nalbuphine group (group N). Routine 0.1 mg/kg midazolam and 2 mg/kg propofol were injected intravenously. After sedation, children in group C, group L, and group N were administered an intravenous injection of saline, lidocaine (10 mg/mL), or nalbuphine hydrochloride (2 mg/mL), respectively, at a dosage of 0.1 mL/kg. Intravenous injection of rocuronium stock solution (0.6 mg/kg) was administered 2 minutes later. Pain was evaluated using Ambeshs 4-pointscale. The incidence of rocuronium injection pain was compared among the three groups, and postoperative adverse reactions, such as drowsiness, bradycardia, hypotension, and respiratory depression, were evaluated.ResultsThe incidence of injection pain among children in group N was significantly lower than that in group C and group L (p<0.05). The incidence of drowsiness in group N was significantly higher than that in the other groups (p<0.05). The incidences of hypotension, bradycardia, and respiratory depression were not significantly different among the three groups (p>0.05).ConclusionsIntravenous nalbuphine during induction of anesthesia effectively prevented rocuronium-associated injection pain in children. Drowsiness is a complication.

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Section: Discussionmentioning

confidence: 98%

Effect of nalbuphine on rocuronium injection pain

Huang

Wang

et al. 2021

World Jnl Ped Surgery

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“…Nevertheless, the regulatory mechanism of RB needs to be further explored, such as how autophagy of fibroblasts regulates the expression of CXCL12. In addition, RB injection will cause severe local pain [ 41 ]. Considering the dose limit of RB, it is of great research value to combine low dose RB with anti-tumor chemotherapy drugs to improve the sensitivity and therapeutic effect of chemotherapy drugs.…”

Section: Discussionmentioning

confidence: 99%

Rocuronium bromide suppresses esophageal cancer via blocking the secretion of C–X–C motif chemokine ligand 12 from cancer associated fibroblasts

Wan

et al. 2023

J Transl Med

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Background Cancer associated fibroblasts (CAFs) communicate metabolically with tumor genesis and development. Rocuronium bromide (RB) is reported to exert certain inhibitory effect on tumor. Here, we investigate the role of RB in esophageal cancer (EC) malignant progression. Methods Tumor xenograft models with EC cells were locally and systemically administrated with RB to detect the influence of different administrations on tumor progression. Mouse CAFs PDGFRα+/F4/80− were sorted by Flow cytometry with specific antibodies. CAFs were treated with RB and co-cultured with EC cells. The proliferation, invasion and apoptosis assays of EC cells were performed to detect the influences of RB targeting CAFs on EC cell malignant progression. Human fibroblasts were employed to perform these detections to confirm RB indirect effect on EC cells. The gene expression changes of CAFs response to RB treatment were detected using RNA sequencing and verified by Western blot, immunohistochemistry and ELISA. Results Tumors in xenograft mice were observed significantly inhibited by local RB administration, but not by systemic administration. Moreover EC cells did not show obvious change in viability when direct stimulated with RB in vitro. However, when CAFs treated with RB were co-cultured with EC cells, obvious suppressions were observed in EC cell malignancy, including proliferation, invasion and apoptosis. Human fibroblasts were employed to perform these assays and similar results were obtained. RNA sequencing data of human fibroblast treated with RB, and Western blot, immunohistochemistry and ELISA results all showed that CXCL12 expression was significantly diminished in vivo and in vitro by RB. EC cells direct treated with CXCL12 showed much higher malignancy. Moreover cell autophagy and PI3K/AKT/mTOR signaling pathway in CAFs were both suppressed by RB which can be reversed by Rapamycin pretreatment. Conclusions Our data suggest that RB could repress PI3K/AKT/mTOR signaling pathway and autophagy to block the CXCL12 expression in CAFs, thereby weakening the CXCL12-mediated EC tumor progression. Our data provide a novel insight into the underlying mechanism of RB inhibiting EC, and emphasize the importance of tumor microenvironment (cytokines from CAFs) in modulating cancer malignant progression.

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“…It is well known that rocuronium injections elicit an intense burning pain, and this often appears as a withdrawal movement during anesthesia induction. 13 , 14 The withdrawal reaction has a wide spectrum of reactions from no response to generalized movement. 14 …”

Section: Introductionmentioning

confidence: 99%

“… 13 , 14 The withdrawal reaction has a wide spectrum of reactions from no response to generalized movement. 14 …”

Section: Introductionmentioning

confidence: 99%

Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial

Kim

Roh

Lee

et al. 2018

TCRM

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PurposeThe development of emergence agitation (EA) is associated with several factors including age, preoperative anxiety, postoperative pain, anesthesia method, and surgery type. No studies have investigated whether the withdrawal reaction following rocuronium injection can predict the occurrence of EA. Therefore, we investigated this relationship in preschool-aged children undergoing inguinal herniorrhaphy, and which grade of withdrawal reaction is appropriate for identifying patients at risk of experiencing EA.MethodsA total of 40 patients were enrolled in this study. During anesthesia induction, the withdrawal reaction after loss of consciousness following rocuronium injection was assessed using a 4-point scale. After surgery, EA was assessed using the Watcha scale.ResultsThere was a correlation between withdrawal reaction and EA on admission to the postanesthesia care unit (PACU). Patients with a severe withdrawal reaction (grade 3) showed a significantly higher incidence of severe EA requiring medication on admission to the PACU.ConclusionThe findings of this preliminary exploratory observational study suggest that it is possible for withdrawal movement following rocuronium injection during anesthesia induction to reflect pain sensitivity of pediatric patients, which in turn may be useful in identifying those at risk of severe EA on admission to the PACU among preschool children undergoing inguinal herniorrhaphy. Further studies with a larger sample size are required to validate these findings. The exact correlation between pain reaction following rocuronium injection and postoperative pain or pain-related phenomenon should be elucidated.

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Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults

Cited by 8 publications

References 80 publications

Effect of nalbuphine on rocuronium injection pain

Effect of nalbuphine on rocuronium injection pain

Rocuronium bromide suppresses esophageal cancer via blocking the secretion of C–X–C motif chemokine ligand 12 from cancer associated fibroblasts

Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial

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