Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial.
OBJECTIVE
To determine (1) the amount of 8.4% sodium bicarbonate (NaHCO(3)) to adjust the pH of rocuronium to 7.4 (neutralization), (2) to show whether neutralizing the pH of rocuronium can prevent pain, and (3) to confirm that rocuronium mixed with NaHCO(3) does not change the physical property and efficacy of rocuronium.


METHODS
Prospective studies.


METHODS
University medical center.


METHODS
180 ASA physical status I and II women patients undergoing elective gynecologic surgery.


METHODS
60 patients were randomly allocated to group 1 (rocuronium only), group 2 (rocuronium 50 mg mixed with 0.9% NaCl 3 mL), and group 3 (rocuronium 50 mg mixed with 8.4% NaHCO(3) 3 mL). All patients received mixtures equal to 0.04 mg/kg of rocuronium and were asked to evaluate their pain with visual analog scale (VAS) and pain scores. In other settings, the onset time and duration of action of each group of rocuronium were measured. The dose of rocuronium required to produce a 50% twitch depression (ED(50)) was calculated.


RESULTS
The amount of 8.4% NaHCO(3) needed to neutralize 50 mg of rocuronium was 3.1 +/- 0.3 mL. VAS scores were lower in group 3 than in groups 1 or 2 (P < 0.05). There were no differences in onset time, duration of action, or ED(50) values among the groups.


CONCLUSIONS
Rocuronium neutralized with NaHCO(3) prevents intravenous injection pain. The physical and pharmacologic properties of rocuronium mixed with NaHCO(3) immediately before administration are not altered.
Han
Dong Woo
DW
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, CPO Box 8044, Seoul 120-752, Korea.
Koo
Bon Nyeo
BN
Choi
Seung Ho
SH
Lee
Jong Seok
JS
Shin
Yang Sik
YS
Sharma
Manohar
M
Kim
Ki Jun
KJ
D000328:Adult; D000732:Androstanols / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007267:Injections / Q000009:adverse effects; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control*; D011446:Prospective Studies; D000077123:Rocuronium; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D013997:Time Factors; D014851:Wakefulness
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D017693:Sodium Bicarbonate; D000077123:Rocuronium