Journal of Anesthesia

, Volume 27, Issue 5, pp 742–749

Pharmacological prevention of rocuronium-induced injection pain or withdrawal movements: a meta-analysis

  • Hyun Jeong Kwak
  • Ji Young Kim
  • Yong Beom Kim
  • Sang Kee Min
  • Bong Ki Moon
  • Jong Yeop Kim
Review Article

DOI: 10.1007/s00540-013-1595-7

Cite this article as:
Kwak, H.J., Kim, J.Y., Kim, Y.B. et al. J Anesth (2013) 27: 742. doi:10.1007/s00540-013-1595-7

Abstract

Rocuronium is reported to be associated with injection pain or withdrawal movement (IPWM). This meta-analysis assessed the efficacy of different pharmacological treatments used to decrease the incidence of the rocuronium-induced IPWM. We searched the Cochrane Library, Embase and PubMed for randomized controlled trials comparing a pharmacological drug with a placebo to prevent the rocuronium-induced IPWM and found 37 studies with 5,595 patients. Overall incidence of rocuronium-induced IPWM was 74 %. Pretreatment with opioids [risk ratio (RR) 0.16; 95 % confidence interval (95 % CI) 0.09—0.29], lidocaine (0.47; 0.35–0.64), and ketamine (0.41; 0.22–0.77) were effective in decreasing IPWM. Lidocaine pretreatment with venous occlusion (0.40; 0.32–0.49) and opioids pretreatment with venous occlusion (0.77; 0.61–0.96) were also effective. Mixing sodium bicarbonate (NaHCO3) with rocuronium (0.15; 0.06–0.34) was also efficacious in reducing IPWM. Indirect comparison shows that the RR of NaHCO3 admixture and pretreatment with opioids were lower than that of the other four interventions (pretreatments of ketamine or lidocaine, and lidocaine or opioids with venous occlusion). This meta-analysis suggests that opioids, lidocaine, ketamine, and NaHCO3 are effective in decreasing rocuronium-induced IPWM. Considering the efficacy and convenience, pretreatment with opioids without venous occlusion is recommended for reducing rocuronium-induced IPWM.

Keywords

AnesthesiaMeta-analysisRocuroniumPainInjectionPrevention

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Hyun Jeong Kwak
    • 1
  • Ji Young Kim
    • 2
  • Yong Beom Kim
    • 1
  • Sang Kee Min
    • 3
  • Bong Ki Moon
    • 3
  • Jong Yeop Kim
    • 3
  1. 1.Department of Anesthesiology and Pain MedicineGachon University Gil Medical CenterIncheonKorea
  2. 2.Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research InstituteYonsei University College of MedicineSeoulKorea
  3. 3.Department of Anesthesiology and Pain MedicineAjou University School of MedicineSuwonKorea