Yonsei Med J.  2005 Dec;46(6):765-768.

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

• Park JT
• Choi JC
• Yoo YS
• Lee YB
• Kim SY
• Lim HK

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.

Keyword

Pain; rocuronium; thiopental

MeSH Terms

Thiopental/*therapeutic use
Pain Measurement
Pain/chemically induced/*prevention & control
Neuromuscular Nondepolarizing Agents/*adverse effects
Middle Aged
Male
Injections, Intravenous
Humans
Female
*Anesthetics, Intravenous
Androstanols/*adverse effects
Adult

Reference

1. Mayer M, Doenicke A, Hofmann A, Peter K. Onset and recovery of rocuronium (Org 9426) and vecuronium under enflurane anaesthesia. Br J Anaesth. 1992. 69:511–512.

2. Bartkowski RR, Witkowski TA, Azad S, Lessin J, Marr A. Rocuronium onset of action: a comparison with atracurium and vecuronium. Anesth Analg. 1993. 77:574–578.

3. Steegers MA, Robertson EN. Pain on injection of rocuronium bromide. Anesth Analg. 1996. 83:203.

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

5. Moorthy SS, Dierdorf SF. Pain on injection of rocuronium bromide. Anesth Analg. 1995. 80:1067.

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

7. Borgeat A, Kwiatkowski D, Ruetsch YA. Spontaneous movements associated with rocuronium injection: the effects of prior administration of fentanyl. J Clin Anesth. 1997. 9:650–652.

8. 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.

9. 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.

10. 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.

11. Mencke T, Beerhalter U, Fuchs-Buder T. Spontaneous movements, local reactions and pain on injection of rocuronium. A comparison between female and male patients. Acta Anaesthesiol Scand. 2001. 45:1002–1005.

12. 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.

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

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

15. Anker-Moller E, Spangsberg N, Arendt-Nielsen L, Schultz P, Kristensen MS, Bjerring P. Subhypnotic doses of thiopentone and propofol cause analgesia to experimentally induced acute pain. Br J Anaesth. 1991. 66:185–188.

16. Agarwal A, Ansari MF, Gupta D, Pandey R, Raza M, Singh PK, et al. Pretreatment with thiopental for prevention of pain associated with propofol injection. Anesth Analg. 2004. 98:683–686.

17. Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988. 43:492–494.