J Korean Med Sci.  2009 Oct;24(5):879-882. 10.3346/jkms.2009.24.5.879.

Antihistamine Pretreatment to Reduce Incidence of Withdrawal Movement After Rocuronium Injection

• Lee HJ
• Han SJ
• Kim H
• Lee IO
• Kong MH
• Kim NS
• Lim SH
• Lee MK

• KMID: 1782010
• DOI: http://doi.org/10.3346/jkms.2009.24.5.879

Abstract

The purpose of this study was to determine the effectiveness of antihistamine therapy for withdrawal movements caused by rocuronium injection. One hundred seventy one ASA I-II adults undergoing elective surgery were randomly assigned to one of two groups. Patients in the control group (Group C) were premedicated with 2 mL normal saline, and those in the antihistamine group (Group A) were pre-medicated with 2 mL (45.5 mg) pheniramine maleate. After the administration of thiopental sodium 5 mg/kg, rocuronium 0.6 mg/kg was injected. Withdrawal movements were assessed using a four-grade scale. The administration of antihistamine reveals lower grade of withdrawal movement after rocuronium injection.

Keyword

Antihistamine; Pain; Rocuronium

MeSH Terms

Adult
Androstanols/*administration & dosage/adverse effects
Anesthetics, Intravenous/administration & dosage
Double-Blind Method
Female
Histamine H1 Antagonists/*pharmacology
Humans
Incidence
Injections, Intravenous
Male
Middle Aged
Movement/drug effects/physiology
Neuromuscular Nondepolarizing Agents/*administration & dosage/adverse effects
Pain/chemically induced
Pain Measurement
Pheniramine/*pharmacology
Thiopental/administration & dosage

Figure

• 

  Fig. 1 Response to administration of rocuronium in patients pretreated with antihistamine versus saline depends on intravenous catheter site. Values represent numbers of patients or withdrawal grade.

Reference

1. Ahmad N, Choy CY, Aris EA, Balan S. Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine. Anesth Analg. 2005. 100:987–990.

2. Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth. 2000. 84:106–107.

3. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg. 2002. 94:1517–1520.

4. Chiarella AB, Jolly DT, Huston CM, Clanachan AS. Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium. Br J Anaesth. 2003. 90:377–379.

5. Koda H, Minagawa M, Si-Hong L, Mizumura K, Kumazawa T. H1-receptor-mediated excitation and facilitation of the heat response by histamine in canine visceral polymodal receptors studied in vitro. J Neurophysiol. 1996. 76:1396–1404.

6. Blunk JA, Seifert F, Schmelz M, Reeh PW, Koppert W. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol. 2003. 20:245–253.

7. Koppert W, Blunk JA, Petersen LJ, Skov P, Rentsch K, Schmelz M. Different patterns of mast cell activation by muscle relaxants in human skin. Anesthesiology. 2001. 95:659–667.

8. Nagy I. Evers AS, Maze M, editors. Sensory processing. Anesthetic Pharmacology: Physiologic principles and Clinical Practice. 2004. 1st ed. Philladelphia: Elsevier Inc.;187–198.

9. Simone DA, Alreja M, LaMotte RH. Psychophysical studies of the itch sensation and itchy skin ("alloknesis") produced by intracutaneous injection of histamine. Somatosens Mot Res. 1991. 8:271–279.

10. Arndt JO, Klement W. Pain evoked by polymodal stimulation of hand veins in humans. J Physiol. 1991. 440:467–478.

11. Lui JT, Huang SJ, Yang CY, Hsu JC, Lui PW. Rocuronium-induced generalized spontaneous movements cause pulmonary aspiration. Chang Gung Med J. 2002. 25:617–620.

12. Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium: is pain on injection the cause? Br J Anaesth. 1997. 79:382–383.

13. Klement W, Arndt JO. Pain on i.v. injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations. Br J Anaesth. 1991. 66:189–195.

14. Choi BI, Choi SH, Shin YS, Lee SJ, Yoon KB, Shin SK, Lee KY. Remifentanil prevents withdrawal movements caused by intravenous injection of rocuronium. Yonsei Med J. 2008. 49:211–216.

15. Turan A, Memis D, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by magnesium sulphate, lignocaine, sodium bicarbonate and alfentanil. Anaesth Intensive Care. 2003. 31:277–281.

16. Chin TM, Fellner MJ. Allergic hypersensitivity to lidocaine hydrochloride. Int J Dermatol. 1980. 19:147–148.

17. Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Can J Anaesth. 1991. 38:330–334.

18. Joshi GP, Warner DS, Twersky RS, Fleisher LA. A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study. J Clin Anesth. 2002. 14:494–499.

19. Orhan ME, Yuksel U, Bilgin F, Dogrul A. Comparison of the local anesthetic effects of chlorpheniramine, midazolam, lidocaine, and normal saline after intradermal injection. Med Sci Monit. 2007. 13:PI7–PI11.

20. Raffa RB. Antihistamines as analgesics. J Clin Pharm Ther. 2001. 26:81–85.

21. Apiliogullari S, Keles B, Apiliogullari B, Balasar M, Yilmaz H, Duman A. Comparison of diphenhydramine and lidocaine for prevention of pain after injection of propofol: a double-blind, placebo-controlled, randomized study. Eur J Anaesthesiol. 2007. 24:235–238.

22. Green SM, Rothrock SG, Gorchynski J. Validation of diphenhydramine as a dermal local anesthetic. Ann Emerg Med. 1994. 23:1284–1289.

23. Witte PU, Irmisch R, Hajdu P. Pharmacokinetics of pheniramine (Avil) and metabolites in healthy subjects after oral and intravenous administration. Int J Clin Pharmacol Ther Toxicol. 1985. 23:59–62.

24. Dalgleish DJ. Drugs which cause pain on intravenous injection. Anaesthesia. 2000. 55:828–829.