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British Journal of Anaesthesia, 2003, Vol. 90, No. 3 377-379
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Short Communications

Comparison of four strategies to reduce the pain associated with intravenous administration of rocuronium

A. B. Chiarella*,1, D. T. Jolly*,1, C. M. Huston1 and A. S. Clanachan2

1 Department of Anesthesiology and Pain Medicine, 3B2.32 Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospitals, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7. 2 Faculty of Pharmacy and Pharmaceutical Science, 3118 Dentistry-Pharmacy Centre, University of Alberta, Edmonton, Alberta, Canada T6G 2N8

Corresponding authors: E-mail: dtjolly@compusmart.ab.ca and achiarel@ualberta.ca

Background. I.V. rocuronium produces intense discomfort at the site of injection in conscious patients. Four strategies to reduce or prevent this discomfort were studied.

Methods. Two hundred and fifty adult patients, ASA I–III, were randomized into five groups of 50 patients in a blinded, prospective study. The control group received rocuronium 10 mg alone. For the remaining four groups, rocuronium 10 mg was mixed with sodium bicarbonate 8.4% 2 ml, fentanyl 100 µg, lidocaine 2% or normal saline. The pH and osmolality of all mixtures were measured. Patient data were analysed using ordinal logistic regression. Osmolality and pH data were analysed using the Kruskal–Wallis test with Dunn’s multiple comparison test.

Results. When compared with rocuronium alone, only the addition of saline failed to significantly reduce the pain reported by patients. The addition of fentanyl reduced the complaint of pain by 1.9 times (P<0.049) and the addition of lidocaine 2% reduced it by 3.6 times (P<0.0001). Sodium bicarbonate 8.4% reduced the reporting of pain by 18.4 times (P<0.0001).

Conclusions. Sodium bicarbonate 8.4%, when added to rocuronium, markedly reduces the experience of pain during the i.v. administration of a small dose of rocuronium.

Br J Anaesth 2003; 90: 377–9


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