title: Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, CPO Box 8044, Seoul 120-752, Korea.
authors.forename: Dong Woo
authors.initials: DW
authors.lastname: Han
authors.forename: Bon Nyeo
authors.initials: BN
authors.lastname: Koo
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jong Seok
authors.initials: JS
authors.lastname: Lee
authors.forename: Yang Sik
authors.initials: YS
authors.lastname: Shin
authors.forename: Manohar
authors.initials: M
authors.lastname: Sharma
authors.forename: Ki Jun
authors.initials: KJ
authors.lastname: Kim
mesh_terms: 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
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D017693:Sodium Bicarbonate; D000077123:Rocuronium