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

Abstract

Background: Rocuronium-associated injection pain/withdrawal response (RAIPWR) was non-ideal but occurred frequently when injection intravenously during anesthesia induction. Many studies had reported that pretreating with antipyretic analgesics (AAs) could reduce the occurrence of RAIPWR, but there was no consensus yet. Therefore, this meta-analysis was designed to systematically evaluate the benefits of AAs on RAIPWR in patients. Methods: PubMed, Cochrane Library, Ovid, EMbase, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Data were searched by January 1st 2019 for randomized controlled trials (RCTs) applying AAs to alleviate RAIPWR in patients who underwent elective surgery under general anesthesia. Two investigators assessed quality of RCTs and extracted data respectively and the meta-analysis was carried on Revman 5.3 software. Moreover, we compared AAs in pros and cons directly with lidocaine, the most reported medicine to prevent RAIPWR. Results: Data were analyzed from 9 RCTs totaling 819 patients. The results of Meta-analysis showed that compared to the control group, pretreating with AAs could prevent the total occurrence of RAIPWR [Risk ratio (RR), 0.52; 95% confidence interval (CI), 0.42 to 0.66; P < 0.0001], and took effect on moderate (RR, 0.56; 95%CI, 0.43 to 0.73; P < 0.0001) and severe RAIPWR (RR = 0.14; 95%CI, 0.08 to 0.24; P < 0.00001). When compared to lidocaine, the preventive effect was not so excellent as the latter but injection pain induced by prophylactic occurred less. Conclusion: The currently available evidence suggested that pretreating with AAs intravenously could alleviate RAIPWR.

Effect of injection pain and withdrawal movement of propofol and rocuronium in the induction of anaesthesia on postoperative pain outcomes in gynaecological laparoscopic surgery: a prospective observational study

“…This observation is consistent with those reported by previous studies. [ 3 4 5 ] This study showed that the severity of pain assessed with NRS and opioid consumption in patients with PIP or RIWM were significantly higher than in patients without PIP or RIWM. Our finding suggests that preoperative pain perception may be used to predict pain outcomes after surgery.…”

“…Propofol and rocuronium, used for induction of general anaesthesia, are often associated with pain (in 25%–100% of patients receiving propofol) or withdrawal movement (in 22%–84% of patients receiving rocuronium). [ 2 3 ] The characteristics of pain associated with propofol and rocuronium are inconsistent. One study reported that the characteristics of pain associated with the two anaesthetic agents are similar in regard to pain during administration, a short duration of pain and a decrease in pain intensity with subsequent injection.…”

“…[ 5 ] Many studies have attempted to reduce the frequency of pain or withdrawal movement after injection of the two drugs. [ 2 3 4 5 6 7 ] There is evidence that the two anaesthetic agents individually may cause injection pain/withdrawal movement during administration. [ 2 3 4 5 6 7 8 9 ] However, few studies have studied the impact of pain/withdrawal movement on the severity of postoperative pain and total opioid consumption.…”

Effect of nalbuphine on rocuronium injection pain

“…The pain can immediately cause withdrawal movements of the arm and hand and may soon extend to the whole body. 5 This type of body movement reactions can lead to increased incidence of pulmonary aspiration in unconscious patients, detachment or displacement of venous catheters, or other emergencies. Therefore, reducing pain caused by rocuronium injection has important consequences in clinical application.…”

“… 6 In addition to drug prophylaxis, studies have shown that the dilution of rocuronium to a lower concentration can also reduce the incidence of injection pain. 5 However, the use of lidocaine alone or of low concentrations of rocuronium alone cannot completely prevent injection pain. Many randomized controlled trials in adults have shown that a variety of opioids, such as fentanyl and sufentanil, can effectively reduce the incidence and severity of pain or muscular fasciculations caused by injection of rocuronium.…”