The Effect of Pretreatment with Thiopental on Reducing Pain Induced by Rocuronium Injection

Abstract

We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p < 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.

Local warming at injection site helps alleviate pain after rocuronium administration

“…Despite such a common occurrence, no single drug or technique has been uniformly incorporated into clinical practice to alleviate this pain. Various preventive methods have been suggested, but none is completely satisfactory, and failure rates are as high as 28-70% [7][8][9]11]. The pathophysiological mechanisms leading to this adverse effect are still unclear.…”

“…As it holds a unique place among the nondepolarizing relaxants, continual efforts have been made to alleviate this painful side effect and various strategies have been proposed. Pretreatment or mixing with a variety of drugs such as thiopental, ondansetron, lidocaine, fentanyl, alfentanil, tramadol esmolol, magnesium sulphate, ketamine, antihistaminics, and sodium bicarbonate has been used in an attempt to reduce this pain [7][8][9][10][11][12][13]. The analgesic action of heat is mediated by the gate-control theory of pain [14].…”

Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial

“…In recent studies with awake patients who received no pretreatment with local anesthetics or opioid, normal saline mixtures decreased rocuronium injection pain because of a dilution effect [7,8]. Dexmedetomidine [9], ketamine [10], and thiopental sodium [11] pretreatments also reduce pain on injection. The low pH of rocuronium solution may be a possible cause of pain, or it may be the local release of nociceptive mediators [2,12].…”

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

“…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]. Seven studies presented a clear explanation for withdrawals and dropouts in each group [12,13,15,16,24,25,33] (Fig.…”