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

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 randomize...

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Bibliographic Details
Published in:Journal of anesthesia 2013-10, Vol.27 (5), p.742-749
Main Authors: Kwak, Hyun Jeong, Kim, Ji Young, Kim, Yong Beom, Min, Sang Kee, Moon, Bong Ki, Kim, Jong Yeop
Format: Article
Language:English
Subjects:
Analgesics - therapeutic use
Analysis
Androstanols - adverse effects
Anesthesiology
Critical Care Medicine
Emergency Medicine
Health aspects
Humans
Injections, Intravenous
Intensive
Lidocaine
Medicine
Medicine & Public Health
Neuromuscular blocking agents
Pain - chemically induced
Pain - drug therapy
Pain - prevention & control
Pain Medicine
Randomized Controlled Trials as Topic
Review Article
Rocuronium bromide
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Summary: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 (NaHCO 3 ) with rocuronium (0.15; 0.06–0.34) was also efficacious in reducing IPWM. Indirect comparison shows that the RR of NaHCO 3 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 NaHCO 3 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.
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-013-1595-7