The effect of intravenous paracetamol for the prevention of rocuronium injection pain

Abstract

Rocuronium is a nondepolarizing neuromuscular blocking agent used in anesthesia induction and is associated with considerable discomfort and burning pain during injection, which is reported to occur in 50-80% of patients. This study was carried out to investigate the effectiveness of intravenous paracetamol pretreatment compared with lidocaine and normal saline to prevent rocuronium injection pain. The study included 150 ASA I-II patients undergoing elective orthopedic, gastrointestinal, and gynecological procedures under general anesthesia. They were allocated into three groups according to pretreatment drugs: lidocaine (40 mg) (n = 50), paracetamol (n = 50), and normal saline group (n = 50). Before anesthesia induction with propofol, all patients were pretreated with rocuronium. The pain caused by the injection was evaluated. Local signs were assessed on the arm at the end of the injection, as well as 24 hours after recovery from anesthesia. There were no patients with blurred speech or vision and there was no respiratory depression in any group after pretreatment with the study drug. The level of pain on injection was statistically lower in those who had received paracetamol compared to normal saline (p = 0.009). There were more patients in the saline group with severe pain (p < 0.001). Paracetamol relieved the rocuronium injection pain better than normal saline but lidocaine was the best of the three drugs (p < 0.001).

Prevention of Withdrawal Movement Associated with the Injection of Rocuronium in Children: Comparison of Paracetamol and Lidocaine

“…Parasetamolün periferik analjezik etkisinin propofol ve roküron-yum enjeksiyon ağrısını önlemedeki etkisini araştıran ça-lışmalar vardır (12,15 Roküronyum enjeksiyon ağrısını önlemede, fentanil, remifentanil gibi opioidler, ketamin, lidokain gibi ajanlar kullanılmıştır. Remifentanilin roküronyum enjeksiyon ağrısına etkisi ile ilgili araştırma sonuçları çelişkilidir.…”

“…Tüm incelemelerde p<0,05 istatistiksel olarak anlamlı kabul edildi. Yeterli hasta sayısını saptamak için daha önce yapılan ve lidokain ile enjeksiyon ağrısı olmama oranı %48, paracetamol kullanıldığında ise %22,5 bulunan bir çalışma referans alındı (15). Çalışmamızda lidokain ve parasetamol grupları arasındaki ağrı olmama oranları arasında %25,5 fark, tip I hata 0,05 ve %80 güç ile saptanabilmesi için gereken örnek-lem büyüklüğü her grup için minimum 43 hasta olarak hesaplandı.…”

The efficacy of Antipyretic Analgesics administration intravenously for Preventing Rocuronium-Associated Pain/Withdrawal Response: a systematic review and meta-analysis

“…We initially identified 84 records according to the retrieval strategy aforementioned, and 9 [10][11][12][13][14][15][16][17][18] of them involving 819 patients were included eventually according to the inclusion and exclusion criteria ( Fig. 1 PRISMA diagram showing article selection for this review).…”

Combination of nefopam and remifentanil is more effective to reduce rocuronium-induced withdrawal response compared with remifentanil alone: a prospective, double-blinded, randomized control study

“…Many clinical studies have tried to reduce the withdrawal response by various pharmacological interventions [2][3][4][5][6][7][8][9][10].…”

“…Some authors suggested that non-opioid analgesics such as tramadol and paracetamol also effectively reduced rocuronium-induced withdrawal response, even though their effects were less than that of lidocaine [4,6]. In addition, serotonin receptor antagonists such as ondansetron and palonosetron were also effective in the prevention of rocuronium-induced withdrawal response, although there is some controversy regarding the effectiveness of serotonin receptor antagonists compared to that of lidocaine [5][6][7][8].…”