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Pharmacological prevention of rocuronium-induced injection pain or withdrawal movements: a meta-analysis

Authors
 Hyun Jeong Kwak  ;  Ji Young Kim  ;  Yong Beom Kim  ;  Sang Kee Min  ;  Bong Ki Moon  ;  Jong Yeop Kim 
Citation
 JOURNAL OF ANESTHESIA, Vol.27(5) : 742-749, 2013 
Journal Title
 JOURNAL OF ANESTHESIA 
ISSN
 0913-8668 
Issue Date
2013
MeSH
Analgesics/therapeutic use* ; Androstanols/adverse effects* ; Humans ; Injections, Intravenous ; Pain/chemically induced* ; Pain/drug therapy ; Pain/prevention & control* ; Randomized Controlled Trials as Topic
Keywords
Anesthesia ; Meta-analysis ; Rocuronium ; Pain ; Injection ; Prevention
Abstract
Rocuronium is reported to be associated with injection pain or withdrawal movement (IPWM). This meta-analysis assessed the efficacy of different pharmacological treatments used to decrease the incidence of the rocuronium-induced IPWM. We searched the Cochrane Library, Embase and PubMed for randomized controlled trials comparing a pharmacological drug with a placebo to prevent the rocuronium-induced IPWM and found 37 studies with 5,595 patients. Overall incidence of rocuronium-induced IPWM was 74%. Pretreatment with opioids [risk ratio (RR) 0.16; 95% confidence interval (95% CI) 0.09-0.29], lidocaine (0.47; 0.35-0.64), and ketamine (0.41; 0.22-0.77) were effective in decreasing IPWM. Lidocaine pretreatment with venous occlusion (0.40; 0.32-0.49) and opioids pretreatment with venous occlusion (0.77; 0.61-0.96) were also effective. Mixing sodium bicarbonate (NaHCO3) with rocuronium (0.15; 0.06-0.34) was also efficacious in reducing IPWM. Indirect comparison shows that the RR of NaHCO3 admixture and pretreatment with opioids were lower than that of the other four interventions (pretreatments of ketamine or lidocaine, and lidocaine or opioids with venous occlusion). This meta-analysis suggests that opioids, lidocaine, ketamine, and NaHCO3 are effective in decreasing rocuronium-induced IPWM. Considering the efficacy and convenience, pretreatment with opioids without venous occlusion is recommended for reducing rocuronium-induced IPWM.
Full Text
http://link.springer.com/article/10.1007%2Fs00540-013-1595-7
DOI
10.1007/s00540-013-1595-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ji Young(김지영) ORCID logo https://orcid.org/0000-0001-5822-0338
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/88054
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