Korean J Anesthesiol.  2013 Jan;64(1):25-28. 10.4097/kjae.2013.64.1.25.

Rocuronium-induced withdrawal movement: influence of ketorolac or a combination of lidocaine and ketorolac pretreatment

• Jeon Y
• Ha JH
• Lee JE
• Lee HC
• Ryu T
• Kwak KH

• KMID: 2236230
• DOI: http://doi.org/10.4097/kjae.2013.64.1.25

Abstract

BACKGROUND
Pain on injection of rocuronium is a common clinical problem. We compared the efficacy of lidocaine, ketorolac, and the 2 in combination as pretreatment for the prevention of rocuronium-induced withdrawal movement.
METHODS
For this prospective, randomized, placebo-controlled, double-blind study a total of 140 patients were randomly allocated to one of 4 treatment groups to receive intravenously placebo (saline), lidocaine (20 mg), ketorolac (10 mg), or both (n = 35 for each group), with venous occlusion. The tourniquet was released after 2 min and anesthesia was performed using 5 mg/kg thiopental sodium followed by 0.6 mg/kg rocuronium. The withdrawal response was graded on a 4-point scale in a double-blind manner.
RESULTS
The overall incidence of withdrawal movements after rocuronium was 34.3% with lidocaine (P = 0.001), 40% with ketorolac (P = 0.004), and 8.6% with both (P < 0.001), compared with 74.3% with placebo. There was a significantly lower incidence of withdrawal movements in patients receiving the lidocaine/ketorolac combination than in those receiving lidocaine or ketorolac alone (P = 0.009 and 0.002, respectively). The incidence of moderate to severe withdrawal movements was 14.3% with lidocaine, 17.2% with ketorolac, and 2.9% with lidocaine/ketorolac combination, as compared to 45.7% with the placebo. There was no significant difference in withdrawal movement between the lidocaine group and the ketorolac group.
CONCLUSIONS
Ketorolac pretreatment had an effect comparable to that of lidocaine in attenuating rocuronium-induced withdrawal movements and the lidocaine/ketorolac combination pretreatment, compared with lidocaine or ketorolac alone, effectively reduced withdrawal movements during rocuronium injection.

Keyword

Injection; Ketorolac; Lidocaine; Pain; Rocuronium

MeSH Terms

Androstanols
Anesthesia
Double-Blind Method
Humans
Incidence
Ketorolac
Lidocaine
Prospective Studies
Thiopental
Tourniquets
Androstanols
Ketorolac
Lidocaine
Thiopental