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

Abstract

Amaç: İntravenöz (i.v) roküronyum enjeksiyonu sonrası hastaların %50-80'i gibi büyük bir kısmında ağrı görülmektedir. Bu araştırma-nın amacı, genel anestezi altında ameliyat geçirecek çocuk hastalarda, i.v. roküronyum enjeksiyonuna bağlı çekme hareketini önlemede, ön-ceden uygulanan i.v. parasetamolün etkinliğini i.v. lidokain ile karşı-laştırmaktır.Yöntemler: Genel anestezi uygulanacak olan 90 hasta basit kura çek-me yöntemi ile rastgele iki gruba ayrıldı; parasetamol grubu (Grup P, n=45) ve lidokain grubu (Grup L, n=45). Anestezi indüksiyonunun ardından tansiyon manşonu 75 mm Hg'ya kadar şişirilerek ven oklüzyonu uygulandı ve Grup P'de i.v. 50 mg parasetamol, Grup L'de i.v. 0,5 mg kg -1 lidokain uygulandı. Ven oklüzyonu 60 saniye (sn) sonra açıldı 0,6 mg kg -1 roküronyum 5 sn'de enjekte edildi. Hastalarda gözlenen hareketler, 4 puanlık bir skala [0: hareket yok, 1: sadece bilekte hareket var, 2: sadece kolda hareket var (dirsek/omuz), 3: bir ekstremiteden daha yaygın hareket] ile değerlendirildi. Bulgular:Kol çekme hareketinin sıklığı parasetamol ve lidokain gruplarında sırasıyla %42 ve %26 olarak tespit edildi (p=0,120). Çekme hareketi görülmeyen ve hafif çekme hareketi görülen hasta sayıları bakımından gruplar arasında fark yokken, orta şiddette çekme hareketi görülen hasta sayısı Grup L ile karşılaştırıldığında, Grup P'de anlamlı olarak fazlaydı (p<0,05). Her iki grupta da hastaların hiçbirinde yaygın hareket görülmedi. Sonuç:Ven oklüzyonu tekniği kullanılarak uygulanan 50 mg parasetamol, roküronyum enjeksiyon ağrısına bağlı çekme hareketini çocuk hastaların %58'inde engeller, ancak orta şiddette çekme hareketini önlemede lidokain kadar etkili değildir. Anahtar kelimeler: Roküronyum, kol çekme hareketi, lidokain, parasetamolObjective: Pain from rocuronium injection is observed in 50%-80 % of patients. This study aimed to compare the effectiveness of pretreatment with paracetamol and lidocaine in preventing pain-induced withdrawal caused by the intravenous injection of rocuronium during the induction of general anaesthesia in paediatric patients.Methods: Ninety children were randomized into two groups using a simple drawing from the box method: a paracetamol group (Group P, n=45) and a lidocaine group (Group L, n=45). After anaesthesia induction, venous occlusion was applied by a paediatric cuff inflated to a pressure of 75 mmHg and by 50 mg paracetamol and 0.5 mg kg −1 lidocaine was injected in Groups P and L, respectively. Venous occlusion was then released, followed by rocuronium injection (0.6 mg kg −1 ). Withdrawal was evaluated using a 4-point scale (1, no response; 2, movement at the wrist only; 3, movement/ withdrawal involving arm only (elbow/shoulder) and 4, generalized response, movement/withdrawal in more than one extremity). Results:The incidence of withdrawal movement was 42% and 26% in the Groups P and L, respectively (p=0.120). Although no significant differences were noted in the number of patients who had no withdrawal movement and mild withdrawal movement in Groups P and L, compared with G...

Study of Effect of Lignocaine in Prevention of Pain and Withdrawal Movements after Intravenous Rocuronium Injection

“…during repeated injection, it has been suggested that this pain is associated with local irritant effect, thus, local anesthetic effect of lignocaine might be useful for preventing this pain. 12 As Cheong et al 5 showed that there was a decrease in pain on injection of rocuronium from 77% to 37% and 7% when lignocaine was given before rocuronium at doses of 10mg and 30mg respectively, we observed that 17 (10.6%) patients complained of mild pain, 4 (2.5%) complained of moderate pain and 1 (0.6%) patient complained of severe pain during injection of rocurounium after intravenous lignocaine.…”

“…Pain due to injection of anesthetic agents is perceived by polymodal nociceptors that innervate the peripheral veins. 12 The pain is more frequent and severe when the drug has non-physiological osmolality or pH values. 13 Rocuronium bromide is formulated with sodium acetate, sodium chloride, or acetic acid to produce a solution of pH 4.…”

“…14 Another mechanism of pain is postulated to be the release of local mediators such as histamine and kinins but lack of erythema and warmth in the surrounding tissue after injection makes it unlikely. 15 Different modalities on prevention of pain on injection of rocuronium have been attempted, including the use of local anaesthetic drugs, 1,12,16,17 opioids, 16,17 ondansetron, 15,17 ketamine, 18 paracetamol, 19,20 sodium bicarbonate, 21 nitrous oxide, 22 sevoflurane, 23 and esmolol. 24 In our study, we used preservative free lignocaine intravenously to prevent the pain after rocuronium injection.…”

“…25,26 When intravenous agents are used for managing pain, their administration through the venous occlusion technique increases their efficiency. 12 The venous occlusion technique is suitable for studying the peripheral action of pretreatment drugs with local effects such as lignocaine, ondansetron or tramadol 16 but is not useful for drugs that act centrally, such as morphine or fentanyl because it prevents the delivery of drugs to the site where they act. We used the venous occlusion technique in our study and the results showed that the local effect of lignocaine was potent.…”

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

“…The remaining 90 studies were reviewed in detail, after which 29 studies were excluded for the following reasons: pediatric study [7, [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], meta-analysis [3,59], and did not report the outcomes of interest [60][61][62][63][64][65][66]. Thus, 61 studies met the inclusion criteria and were included in this systematic review and meta-analysis (Fig.…”