The Effect of Lidocaine or Fentanyl on Withdrawal Movement during Rocuronium Injection

Cho, Hwa Yeon; Kim, Dong Yeon; Chung, Rack Kyung

Abstract

BACKGROUND: This study compared the efficacy of intravenous fentanyl with lidocaine as a pretreatment for the prevention of a withdrawal response after a rocuronium injection.
METHODS
Eighty patients were divided into four groups according to the drugs used for pretreatment as follows: group I: normal saline, group II: lidocaine 0.5 mg/kg, group III: lidocaine 1.0 mg/kg, group IV: fentanyl 1microgram/kg. Twenty seconds after inducing anesthesia, each pretreatment drug was injected. After twenty seconds, rocuronium was injected. The incidence and severity of the withdrawal responses was assessed. The BIS value and heart rate was recorded at each point (T0: baseline, T1: pretreatment drug injection, T2: 10 seconds after pretreatment drug injection, T3: rocuronium injection, T4: 10 seconds after rocuronium injection, T5: 20 seconds after rocuronium injection).
RESULTS
The incidence of withdrawal movement was significantly lower in groups II and III than in groups I and IV (P = 0.002). The BIS was significantly lower in group IV than in groups I, II and III at T2 and group I at T3 (P < 0.05). The heart rate at T4 was significantly lower in group IV than in group II (P < 0.05). An assessment of BIS at the withdrawal movements showed a significantly higher value in the severe group than in the none and mild groups at T5 (P < 0.05).
CONCLUSIONS
A pretreatment with 0.5 mg/kg or 1.0 mg/kg of lidocaine effectively reduced the incidence of a withdrawal response by the rocuronium injection. However, 1.0 mg/kg of lidocaine most effectively prevented the withdrawal response without causing any significant changes in heart rate.