Efficacy of Different Interventions in Preventing Rocuronium-induced Injection Pain or Withdrawal Movements: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGYong-qiang , SHIJuan , LIXin , ZHENGHong ,  WANGJiang

Department of Anesthesiology, the First Affiliated Hospital, Xinjiang Medical University, Urumqi 830054, China;

Corresponding?author：

WANGJiang, Email: 710985359@qq.com

Keywords：

Rocuronium; Injection pain; Withdrawal movements; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160029

Video：

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Objective To systematically evaluate the efficacy of different interventions in preventing rocuroniuminduced injection pain or withdrawal movements, so as to provide references for preventing adverse reactions induced by rocuronium injection in clinical practice. Methods We electronically searched PubMed, EMbase, The Cochrane Library (Issue 3, 2014), CBM, and CNKI databases to collect randomized controlled trials (RCTs) about the prevention of rocuronium-induced injection pain or withdrawal movements from inception to March 2014. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2.8 software. Results A total of 43 RCTs involving 6 034 patients were include. The results of meta-analysis showed that compared with the placebo/blank group, lidocaine pretreatment with venous occlusion (RR=0.37, 95%CI 0.29 to 0.48, P<0.000 01), opioid drug pretreatment with venous occlusion (RR=0.77, 95%CI 0.68 to 0.87, P<0.000 1), lidocaine pretreatment with venous injection (RR=0.51, 95%CI 0.44 to 0.59, P<0.000 01), opioid drug pretreatment with venous injection (OR=0.03, 95%CI 0.02 to 0.05, P<0.000 01), ketamine pretreatment with venous injection (RR=0.36, 95%CI 0.23 to 0.54, P<0.000 01), mixing sodium bicarbonate (NaHCO₃) with rocuronium (OR=0.02, 95%CI 0.01 to 0.04, P<0.000 01) and local heating (RR=0.74, 95%CI 0.63 to 0.88, P=0.000 6) were all effective in decreasing the incidence of rocuronium-induced injection pain or withdrawal movements. Conclusion The intravenous injection of opioid drugs was effective in preventing rocuronium-induced injection pain or withdrawal movements, while local heating needs further research. Due to the limited quantity and quality of the induced studies, the above conclusion still needs to be verified by more high quality studies.

Citation： ZHANGYong-qiang, SHIJuan, LIXin, ZHENGHong, WANGJiang. Efficacy of Different Interventions in Preventing Rocuronium-induced Injection Pain or Withdrawal Movements: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(2): 172-182. doi: 10.7507/1672-2531.20160029 Copy

1.	Steegers MA, Robertson EN. Pain on injection of rocuronium bromide. Anesth Analg, 1996, 83(1):203.
2.	Moorthy SS, Dierdoff SF. Pain on injection of rocuronium bromide. Anesth Analg, 1995, 80(5):1067.
3.	Shevchenko Y, Jocson JC, McRae VA, et al. The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents. Anesth Analg, 1999, 88(4):746-768.
4.	Lui JT, Huang SJ, Yang CY, et al. Rocuronium induced generalized spontaneous movements cause pulmonary aspiration. Chang Gung Med J, 2002, 25(9):617-620.
5.	Abu-Halaweh SA, Aloweidi AK, Qudaisat IY, et al. Comparison of three methods of preventing rocuronium induced pain on injection using venous occlusion technique:a randomized prospective double blind controlled study. Middle East J Anesthesiol, 2013, 22(1):87-92.
6.	Ahmad N, Choy CY, Aris EA, et al. Preventing the withdrawal response associated with rocuronium injection:a comparison of fentanyl with lidocaine. Anesth Analg, 2005, 100(4):987-990.
7.	Akcaboy ZN, Akcaboy EY, Soyal OB, et al. Can ephedrine pretreatment be effective in alleviating rocuronium injection pain? Med Princ Pract, 2012, 21(4):323-327.
8.	Akkaya T, Toygar P, Bedirli N, et al. Effects of pretreatment with lidocaine or ketamine on injection pain and withdrawal movements of rocuronium. Turk J Med Sci, 2008, 38(6):577-582.
9.	Ate? G, K?se EA, ?z G, et al. Effect of paracetamol pretreatment on rocuronium-induced injection pain:a randomized, double-blind, placebo-controlled comparison with lidocaine. Journal of Clinical and Analytical Medicine, 2013, 10(2):1-4.
10.	Ayoglu H, Altunkaya H, Ozer Y, et al. Does dexmedetomidine reduce the injection pain due to protocol and rocuronium? Eur J Anaesthesiol, 2007, 24(6):541-545.
11.	Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium:is pain on injection the cause? Br J Anaesth, 1997, 79(3):382-383.
12.	Cheong KF, Wong WH. Pain on injection of rocuronium:influence of two doses of lidocaine pretreatment. Br J Anaesth, 2000, 84(1): 106-107.
13.	Chiarella AB, Jolly DT, Huston CM, et al. Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium. Br J Anaesth, 2003, 90(3):377-379.
14.	Choi BI, Choi SH, Shin YS, et al. Remifentanil prevents withdrawal movements caused by intravenous injection of rocuronium. Yonsei Med J, 2008, 49(2):211-216.
15.	Choi YJ, Park HS, Lee H, et al. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol, 2012, 63(5):413-418.
16.	Ertugrul FA. Comparison of the efficacies of different pretreatment drugs in resolving the injection pain of rocuronium. J Int Med Res, 2006, 34(6):665-670.
17.	Han DW, Koo BN, Choi SH, et al. Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients:a randomized prospective trial. J Clin Anesth, 2007, 19(6):418-423.
18.	Jeon Y, Baek SU, Park SS, et al. Effect of pretreatment with acetaminophen on withdrawal movements associated with injection of rocuronium:a prospective, randomized, double-blind, placebo controlled study. Korean J Anesthesiol, 2010, 59(1):13-16.
19.	Kim E, Kim CH, Kim HK, et al. Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection. J Anesth, 2013, 27(6): 868-873.
20.	Kim JH, Kim JH, Han SH, et al. Alfentanil is comparable to remifentanil in preventing withdrawal movement following rocuronium injection. J Clin Anesth, 2009, 21(1):9-12.
21.	Kim JY, Kim YB, Kwak HJ. Pretreatment with remifentanil to prevent withdrawal after rocuronium in children. Br J Anaesth, 2007, 98(1):120-123.
22.	Kim JY, Kwak HJ, Kim JY, et al. Prevention of rocuronium-induced withdrawal movement in children:a comparison of remifentanil with alfentanil. Paediatr Anaesth, 2008, 18(3):245-250.
23.	Kim KS, Kim YS, Jeon WJ, et al. Prevention of withdrawal associated with the injection of rocuronium in adults and children. J Clin Anesth, 2006, 18(5):334-338.
24.	Kwak HJ, Chae YJ, Lee SY, et al. Combination of nitrous oxide and lidocaine to prevent withdrawal after rocuronium in children. Korean J Anesthesiol, 2010, 58(5):446-449.
25.	Lee SH, Lee CJ, Kim TH, et al. Novel use of hydromorphone as a pretreatment agent:a double-blind, randomized, controlled study in adult Korean surgical patients. Curr Ther Res, 2011, 72(1):36-48.
26.	Lee YC, Jang YH, Kim JM, et al. Rapid injection of rocuronium reduces withdrawal movement on injection. J Clin Anesth, 2009, 21(6):427-430.
27.	Liou JT, Hsu JC, Liu FC, et al. Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients. Anesth Analg, 2003, 97(5): 1294-1297.
28.	Mahajan C, Rath GP, Bithal PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth, 2010, 24(6):845-848.
29.	Memis D, Turan A, Karamanloglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg, 2002, 94(6):1517-1520.
30.	Oh AY, Seo KS, Goo EK, et al. Prevention of withdrawal movement associated with injection of rocuronium in children:comparison of remifentanil, alfentanil and fentanyl. Acta Anaesthesiol Scand, 2007, 51(9):1190-1193.
31.	Prasanna M, Priya V, Divatia JV, et al. Comparison between different strategies to reduce pain on intravenous injection of rocuronium. J Anaesth Clin Pharmacol, 2005, 21(1):59-61.
32.	Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection:a randomised, double-blind controlled comparison with lidocaine. Anaesthesia, 2001, 56(9):902-905.
33.	Sharma S, Sharma D, Jain A, et al. Effect of nitrous oxide on pain due to rocuronium injection:A randomised, double-blind, controlled clinical trial. Indian J Anaesth, 2010, 54(2):142-146.
34.	Singh M, Chauhan H, Rath GP, et al. Effect of narcotic pretreatment on pain after rocuronium injection:a randomized, double-blind controlled comparison with lidocaine. J Anesth, 2007, 21(4):510-512.
35.	Turan A, Memis D, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by magnesiumsulphate, lignocaine, sodium bicarbonate and alfentanil. Anaesth Intensive Care, 2003, 31(3):277-281.
36.	Yavascaoglu B, Kaya FN, Ozcan B. Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium. J Clin Anesth, 2007, 19(6):413-417.
37.	Yoon JR, Jeon Y, Yoo Y, et al. The analgesic effect of remifentanil on prevention of withdrawal response associated with the injection of rocuronium in children:no evidence for a peripheral action. J Int Med Res, 2010, 38(5):1795-1800.
38.	Zhang Y, Xiang Y, Liu J. Prevention of pain on injection of rocuronium:a comparison of lidocaine with different doses of parecoxib. J Clin Anesth, 2012, 24(6):456-459.
39.	曾洪友, 曾思. 不同劑量利多卡因預處理對羅庫溴銨注射痛的影響. 華西醫學, 2010, 8(25):1527-1529.
40.	曾婉華, 歐陽葆怡. 利多卡因、曲馬多和樞復寧對預防羅庫溴銨注藥痛的對比研究. 海南醫學, 2005, 16(8):30-32.
41.	曾婉華, 歐陽葆怡. 芬太尼預防羅庫溴銨注藥痛的研究. 臨床麻醉學雜志, 2007, 23(2):110-112.
42.	陳鴻武, 陳國忠. 泰山醫學院學報編輯部氯普魯卡因防治羅庫溴銨注藥痛效果研究. 泰山醫學院學報, 2012, 33(7):492-495.
43.	陸敏霞, 葉素娟. 利多卡因、芬太尼、曲馬多減輕羅庫溴銨注射痛效果比較. 山東醫藥, 2007, 47(23):79.
44.	王紅珠, 王軍會, 王惠琴, 等. 昂丹司瓊復合利多卡因預防羅庫溴銨注射痛臨床分析. 中國藥物與臨床, 2010, 10(12):1410-1411.
45.	張晗, 劉進. 預注射利多卡因與局部加溫緩解羅庫溴銨注射痛的比較. 華西醫學, 2012, 5(27):707-710.
46.	張永俊, 洪濤, 廖建文, 等. 芬太尼和利多卡因減輕羅庫溴銨注射痛的效果. 江蘇醫藥, 2008, 34(9):938-939.
47.	Kim SK, Kwon MA, Park JS. The amount of 8.4% sodiumbicarbonate needed to neutralize the acidity of rocuronium so as to prevent injection pain. J Clin Anesth, 2008, 20(8):629-630.
48.	Lee HJ, Kim KS, Yeon JT, et al. Potencyand recovery characteristics of rocuronium mixed with sodiumbicarbonate. Anaesthesia, 2010, 65(9):899-903.

1. Steegers MA, Robertson EN. Pain on injection of rocuronium bromide. Anesth Analg, 1996, 83(1):203.
2. Moorthy SS, Dierdoff SF. Pain on injection of rocuronium bromide. Anesth Analg, 1995, 80(5):1067.
3. Shevchenko Y, Jocson JC, McRae VA, et al. The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents. Anesth Analg, 1999, 88(4):746-768.
4. Lui JT, Huang SJ, Yang CY, et al. Rocuronium induced generalized spontaneous movements cause pulmonary aspiration. Chang Gung Med J, 2002, 25(9):617-620.
5. Abu-Halaweh SA, Aloweidi AK, Qudaisat IY, et al. Comparison of three methods of preventing rocuronium induced pain on injection using venous occlusion technique:a randomized prospective double blind controlled study. Middle East J Anesthesiol, 2013, 22(1):87-92.
6. Ahmad N, Choy CY, Aris EA, et al. Preventing the withdrawal response associated with rocuronium injection:a comparison of fentanyl with lidocaine. Anesth Analg, 2005, 100(4):987-990.
7. Akcaboy ZN, Akcaboy EY, Soyal OB, et al. Can ephedrine pretreatment be effective in alleviating rocuronium injection pain? Med Princ Pract, 2012, 21(4):323-327.
8. Akkaya T, Toygar P, Bedirli N, et al. Effects of pretreatment with lidocaine or ketamine on injection pain and withdrawal movements of rocuronium. Turk J Med Sci, 2008, 38(6):577-582.
9. Ate? G, K?se EA, ?z G, et al. Effect of paracetamol pretreatment on rocuronium-induced injection pain:a randomized, double-blind, placebo-controlled comparison with lidocaine. Journal of Clinical and Analytical Medicine, 2013, 10(2):1-4.
10. Ayoglu H, Altunkaya H, Ozer Y, et al. Does dexmedetomidine reduce the injection pain due to protocol and rocuronium? Eur J Anaesthesiol, 2007, 24(6):541-545.
11. Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium:is pain on injection the cause? Br J Anaesth, 1997, 79(3):382-383.
12. Cheong KF, Wong WH. Pain on injection of rocuronium:influence of two doses of lidocaine pretreatment. Br J Anaesth, 2000, 84(1): 106-107.
13. Chiarella AB, Jolly DT, Huston CM, et al. Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium. Br J Anaesth, 2003, 90(3):377-379.
14. Choi BI, Choi SH, Shin YS, et al. Remifentanil prevents withdrawal movements caused by intravenous injection of rocuronium. Yonsei Med J, 2008, 49(2):211-216.
15. Choi YJ, Park HS, Lee H, et al. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol, 2012, 63(5):413-418.
16. Ertugrul FA. Comparison of the efficacies of different pretreatment drugs in resolving the injection pain of rocuronium. J Int Med Res, 2006, 34(6):665-670.
17. Han DW, Koo BN, Choi SH, et al. Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients:a randomized prospective trial. J Clin Anesth, 2007, 19(6):418-423.
18. Jeon Y, Baek SU, Park SS, et al. Effect of pretreatment with acetaminophen on withdrawal movements associated with injection of rocuronium:a prospective, randomized, double-blind, placebo controlled study. Korean J Anesthesiol, 2010, 59(1):13-16.
19. Kim E, Kim CH, Kim HK, et al. Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection. J Anesth, 2013, 27(6): 868-873.
20. Kim JH, Kim JH, Han SH, et al. Alfentanil is comparable to remifentanil in preventing withdrawal movement following rocuronium injection. J Clin Anesth, 2009, 21(1):9-12.
21. Kim JY, Kim YB, Kwak HJ. Pretreatment with remifentanil to prevent withdrawal after rocuronium in children. Br J Anaesth, 2007, 98(1):120-123.
22. Kim JY, Kwak HJ, Kim JY, et al. Prevention of rocuronium-induced withdrawal movement in children:a comparison of remifentanil with alfentanil. Paediatr Anaesth, 2008, 18(3):245-250.
23. Kim KS, Kim YS, Jeon WJ, et al. Prevention of withdrawal associated with the injection of rocuronium in adults and children. J Clin Anesth, 2006, 18(5):334-338.
24. Kwak HJ, Chae YJ, Lee SY, et al. Combination of nitrous oxide and lidocaine to prevent withdrawal after rocuronium in children. Korean J Anesthesiol, 2010, 58(5):446-449.
25. Lee SH, Lee CJ, Kim TH, et al. Novel use of hydromorphone as a pretreatment agent:a double-blind, randomized, controlled study in adult Korean surgical patients. Curr Ther Res, 2011, 72(1):36-48.
26. Lee YC, Jang YH, Kim JM, et al. Rapid injection of rocuronium reduces withdrawal movement on injection. J Clin Anesth, 2009, 21(6):427-430.
27. Liou JT, Hsu JC, Liu FC, et al. Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients. Anesth Analg, 2003, 97(5): 1294-1297.
28. Mahajan C, Rath GP, Bithal PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth, 2010, 24(6):845-848.
29. Memis D, Turan A, Karamanloglu B, et al. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg, 2002, 94(6):1517-1520.
30. Oh AY, Seo KS, Goo EK, et al. Prevention of withdrawal movement associated with injection of rocuronium in children:comparison of remifentanil, alfentanil and fentanyl. Acta Anaesthesiol Scand, 2007, 51(9):1190-1193.
31. Prasanna M, Priya V, Divatia JV, et al. Comparison between different strategies to reduce pain on intravenous injection of rocuronium. J Anaesth Clin Pharmacol, 2005, 21(1):59-61.
32. Reddy MS, Chen FG, Ng HP. Effect of ondansetron pretreatment on pain after rocuronium and propofol injection:a randomised, double-blind controlled comparison with lidocaine. Anaesthesia, 2001, 56(9):902-905.
33. Sharma S, Sharma D, Jain A, et al. Effect of nitrous oxide on pain due to rocuronium injection:A randomised, double-blind, controlled clinical trial. Indian J Anaesth, 2010, 54(2):142-146.
34. Singh M, Chauhan H, Rath GP, et al. Effect of narcotic pretreatment on pain after rocuronium injection:a randomized, double-blind controlled comparison with lidocaine. J Anesth, 2007, 21(4):510-512.
35. Turan A, Memis D, Karamanlioglu B, et al. The prevention of pain from injection of rocuronium by magnesiumsulphate, lignocaine, sodium bicarbonate and alfentanil. Anaesth Intensive Care, 2003, 31(3):277-281.
36. Yavascaoglu B, Kaya FN, Ozcan B. Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium. J Clin Anesth, 2007, 19(6):413-417.
37. Yoon JR, Jeon Y, Yoo Y, et al. The analgesic effect of remifentanil on prevention of withdrawal response associated with the injection of rocuronium in children:no evidence for a peripheral action. J Int Med Res, 2010, 38(5):1795-1800.
38. Zhang Y, Xiang Y, Liu J. Prevention of pain on injection of rocuronium:a comparison of lidocaine with different doses of parecoxib. J Clin Anesth, 2012, 24(6):456-459.
39. 曾洪友, 曾思. 不同劑量利多卡因預處理對羅庫溴銨注射痛的影響. 華西醫學, 2010, 8(25):1527-1529.
40. 曾婉華, 歐陽葆怡. 利多卡因、曲馬多和樞復寧對預防羅庫溴銨注藥痛的對比研究. 海南醫學, 2005, 16(8):30-32.
41. 曾婉華, 歐陽葆怡. 芬太尼預防羅庫溴銨注藥痛的研究. 臨床麻醉學雜志, 2007, 23(2):110-112.
42. 陳鴻武, 陳國忠. 泰山醫學院學報編輯部氯普魯卡因防治羅庫溴銨注藥痛效果研究. 泰山醫學院學報, 2012, 33(7):492-495.
43. 陸敏霞, 葉素娟. 利多卡因、芬太尼、曲馬多減輕羅庫溴銨注射痛效果比較. 山東醫藥, 2007, 47(23):79.
44. 王紅珠, 王軍會, 王惠琴, 等. 昂丹司瓊復合利多卡因預防羅庫溴銨注射痛臨床分析. 中國藥物與臨床, 2010, 10(12):1410-1411.
45. 張晗, 劉進. 預注射利多卡因與局部加溫緩解羅庫溴銨注射痛的比較. 華西醫學, 2012, 5(27):707-710.
46. 張永俊, 洪濤, 廖建文, 等. 芬太尼和利多卡因減輕羅庫溴銨注射痛的效果. 江蘇醫藥, 2008, 34(9):938-939.
47. Kim SK, Kwon MA, Park JS. The amount of 8.4% sodiumbicarbonate needed to neutralize the acidity of rocuronium so as to prevent injection pain. J Clin Anesth, 2008, 20(8):629-630.
48. Lee HJ, Kim KS, Yeon JT, et al. Potencyand recovery characteristics of rocuronium mixed with sodiumbicarbonate. Anaesthesia, 2010, 65(9):899-903.

Chinese Journal of Evidence-Based Medicine

Efficacy of Different Interventions in Preventing Rocuronium-induced Injection Pain or Withdrawal Movements: A Meta-analysis

Abstract Full text Figures/Tables Video References Cited by

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