Effect of pretreatment with acetaminophen on withdrawal movements associated with injection of rocuronium: a prospective, randomized, double-blind, placebo controlled study

Abstract

BackgroundWithdrawal movement during rocuronium injection is a common, unresolved adverse effect. We aimed to investigate the effect of IV acetaminophen pretreatment on withdrawal movement during rocuronium injection.MethodsThis study enrolled 120 American Society of Anesthesiologists (ASA) I-II patients undergoing general anesthesia. They were randomly assigned to three treatment groups. After occluding venous drainage using a tourniquet on the upper arm, the saline group received 5 ml of 0.9% sodium chloride solution, the lidocaine group received 40 mg of lidocaine, and the acetaminophen group received 50 mg of acetaminophen. During injection of pretreatment drug, pain was assessed on a four-point scale. The tourniquet was released after 120 seconds and anesthesia was performed using thiopental sodium 5 mg/kg followed by rocuronium 0.6 mg/kg. The withdrawal movement was graded on a four-point scale in a double-blind manner.ResultsThe incidence of pain on pretreatment injection in saline, lidocaine, and acetaminophen groups was 7.7%, 5.1%, and 2.5%, respectively. The incidence of withdrawal movements was 77.5% in saline group, 32.5% in lidocaine group, and 37.5% in acetaminophen group (P < 0.05).ConclusionsAcetaminophen and lidocaine reduced the incidence of withdrawal movement after rocuronium injection compared with saline.

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

“…Remifentanilin roküronyum enjeksiyon ağrısına etkisi ile ilgili araştırma sonuçları çelişkilidir. Ven oklüzyonu tekniği kullanılarak çocuklarda lidokain ile remifentanil ve fentanilin karşılaştırıldığı bir araştırmanın bulgularına göre remifentanil lidokain kadar etkili bulunmazken, çocuklarda remifentanilin serum fizyolojik ile karşılaştırıldığı bir araştır-mada remifentanil hastaların %77'sinde enjeksiyon ağrısını engellediği gösterilmiştir (3, 23,24). Aynı çalışmada fentanil roküronyum ağrısını önlemekte etkili bulunmamıştır (3).…”

Pharmacological and non-pharmacological intervention for rocuronium-induced withdrawal movement in the Korean population: a meta-analysis of 41 studies including 4,742 subjects

“…Thirteen studies mentioned the method of random sequence generation [11,12,13,14,15,16,17,18,19,20,21,22,23], and 10 studies used allocation concealment [11,14,23,24,25,26,27,28,29,30]. Patients were blinded in 39 studies [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49], whereas outcome assessors were blinded in 25 studies [11,12,13,16,17,18,19,20,21,22,23,24,25,27,28,29,30,31,34,35,36,37,38,40,42].…”

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).…”