The amount of 8.4% sodium bicarbonate needed to neutralize the acidity of rocuronium so as to prevent injection pain

Local warming at injection site helps alleviate pain after rocuronium administration

“…It has been advocated that the allogenic effect can be attributed to a direct activation of C-nociceptors by osmolality or pH of the solution or activation by release of endogenous mediators such as histamine, kinin, and other substances mediating inflammation [15,16]. The efficacy and stability of the mixed drug solutions should be evaluated before clinical application because, once mixed, they may become unstable [17] or may be precipitated. In addition, in the presence of other adjuvant treatment, they may lose efficacy and/or potency.…”

Another case of a McCoy blade problem!

“…We also wonder whether this potential for injury with the McCoy blade happens more frequently than is realised or reported. Potency and recovery characteristics of rocuronium mixed with sodium bicarbonate I appreciate that the detailed methodology is almost certainly described in the previous triad of papers [1][2][3], but I would welcome clarification of whether the 10-ml syringe (originally containing 5 ml rocuronium 1%) was gradually filled to a total volume of 10 ml with sodium bicarbonate 8.4% or saline 0.9% [4]? If readers were to try the 'recipe', are the simplified details that a 5 mg.ml )1 solution of rocuronium should be prepared by gradual dilution of 5 ml 'neat' rocuronium to a total volume of 10 ml with sodium bicarbonate 8.4%?…”

A reply

“…The sequences should then have been subjected to probit regression analysis as a backup or sensitivity test. We calculated the ED 50 by averaging the midpoint concentration of all independent pairs of patients involving a crossover according to Dixon and Massey's method [2,3] .............................................................................................................................................................................................................. We faced a similar situation in our hospital and wish to share our experience.…”