Dexmedetomidine Reduces Pain Associated With Rocuronium Injection Without Causing a Decrease in BIS Values

Joo, Jin; Baek, Jungwon; Lee, Jaemin

doi:10.1097/01.sa.0000464144.37909.5f

Cited by 1 publication

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“…summarizes the characteristics of the 61 studies that met the inclusion criteria. The pharmacological strategies used to prevent RIPR or RIWR consisted of lidocaine (Lido) [4, 10-22, 27, 67-82, 82, 84-91], fentanyl (Fent) [4, 14,23,67,75,82,88], oxycodone (Oxyc) [92], deketoprofen [93], dexmedetomidine (Dexm) [10,11], a combination of dexmedetomidine and lidocaine (Dexm + Lido) [10], gabapentin (Gaba) [9,94], N 2 O [12,25,95], a combination of lidocaine and N 2 O (Lido + N 2 O) [12,16], remifentanil (Remi) [70,72,96], alfentanil (Alfe) [27,74,96], nafamostat mesilate [97], peniramine (Peni) [24], normal saline dilution (NS_dilu) [5, [98][99][100][101][102][103][104], rocuronium mixed with lidocaine (Lido_mix) [5,54], ondansetron (Onda) [14,85,88,91,105], tramadol (Tram) [14,21,91], thiopental (Thio) …”

Section: Study Selectionmentioning

confidence: 99%

“…Therefore, various strategies to prevent the rocuroniuminduced pain response (RIPR) and RIWR such as the use of lidocaine [4, [10][11][12][13][14][15][16][17][18][19][20][21][22], opioids [4, 14,23], β-blockers [17], antihistamines [24], nitrous oxide (N 2 O) [12,25], magnesium sulfate (MgSO 4 ) [26], ketamine [20], and sodium bicarbonate (NaHCO 3 ) [27], as well as the dilution of rocuronium with normal saline [5] have been attempted and suggested by anesthesiologists.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological interventions for preventing rocuronium-induced pain responses and rocuronium-induced withdrawal responses: a systematic review and network meta-analysis

2020

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Study objective: Rocuronium is widely used during the induction of general anesthesia. However, it is associated with rocuronium-induced pain response, which can appear as a rocuronium-induced withdrawal response. The purpose of this study was to compare the effectiveness of pharmacological interventions in preventing rocuronium-induced pain response and rocuronium-induced withdrawal response using a network meta-analysis. Design: Systematic review and network meta-analysis (NMA) of RCTs. Setting: Pharmacological interventions to prevent rocuronium-induced pain response and rocuronium-induced pain response and rocuronium-induced withdrawal. Data sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar were systematically searched from its inception until Mar 2020. Methods: We searched multiple databases and extracted randomized controlled trials that compared two or more pharmacological interventions to prevent rocuronium-induced pain response and rocuronium-induced withdrawal response in adult patients who received rocuronium injections for general anesthesia. We conducted network meta-analysis and used surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacological interventions evaluated. Results: In total, 43 studies (5,291 patients) were included in this network meta-analysis and 31 pharmacological interventions were evaluated. The rankogram and cumulative ranking plot showed that oxycodone followed by a combination of lidocaine and sodium bicarbonate (NaHCO3), esmolol, alfentanil, and rocuronium mixed with NaHCO3 had the lowest frequency of rocuronium-induced withdrawal response. In terms of rocuronium-induced pain response, NaHCO3 mixed with rocuronium showed the lowest frequency, followed by a combination of lidocaine and NaHCO3, a combination of lidocaine and nitrous oxide, rocuronium mixed with lidocaine, and lidocaine. Conclusions: Lidocaine administration has been shown to reduce the incidence of rocuronium-induced pain response regardless of the method of injection or drug combination. The combination of lidocaine and NaHCO3 or mixing NaHCO3with rocuronium was effective at reducing rocuronium-induced withdrawal response. In particular, oxycodone was shown to be more effective than the other opioids evaluated and esmolol was also found to be effective at reducing rocuronium-induced withdrawal response.

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