title: Comparison of three methods of preventing rocuronium induced pain on injection using venous occlusion technique: a randomized prospective double blind controlled study.
abstract: BACKGROUND
  Intravenous administration of rocuronium bromide causes pain at the site of injection in most patients. The mechanism that leads to this side effect is still unknown and multiple drugs' pretreatments were used to prevent its occurrence with varying success rates.
  
  
  OBJECTIVE
  The study aimed to evaluate the effects of the pretreatment with lidocaine, fentanyl, and remifentanil using a venous occlusion technique in preventing pain caused by intravenous injection of rocuronium during induction of general anesthesia.
  
  
  METHODS
  Two hundred patients, ASA I-II, requiring various types of surgical procedures under general anesthesia with muscle relaxation and mechanical ventilation, were enrolled. Patients were pre-educated to report pain severity on rocuronium injection on a 4-point severity scale. Patients were allocated randomly using sealed envelopes method into one of four pretreatment groups: (Xylocaine group, 50), Remifentanyl group 50), (Fentanyl group, 50), and (Normal saline group, 50). After venous occlusion, study drugs were injected and the venous occlusion was maintained for one minute. Rocuronium was then administered and patients were asked to report their pain
  
  
  RESULTS
  Compared to control group, all pretreatment drugs were effective in reducing pain on rocuronium injection. Xylocaine was the most effective (Mean difference-1.42, P <0.001), followed by Remifentanil (Mean difference-1.32, P <0.001) and Fentanyl (Mean difference-0.50, P <0.001) in reducing pain on rocuronium injection. Remifentanil was statistically comparable to Xylocaine (P = 0.820) and both drugs were superior to Fentanyl in reducing pain on rocuronium injection.
  
  
  CONCLUSIONS
  Remifentanyl is a better choice of opioid in preventing pain on rocuronium injection using venous occlusion technique than fentanyl, with efficacy comparable to Xylocaine.
authors.affiliation: Department of Anesthesia and ICU, Faculty of Medicine, University of Jordan and Jordan University Hospital Oueen Rania Street, Amman 11940 Jordan. taima_halaweh@yahoo.com
authors.forename: S A
authors.initials: SA
authors.lastname: Abu-Halaweh
authors.forename: A K
authors.initials: AK
authors.lastname: Aloweidi
authors.forename: I Y
authors.initials: IY
authors.lastname: Qudaisat
authors.forename: M O
authors.initials: MO
authors.lastname: Al-Hussami
authors.forename: B S
authors.initials: BS
authors.lastname: Atyat
authors.forename: M
authors.initials: M
authors.lastname: Al-Mustafa
authors.forename: N S
authors.initials: NS
authors.lastname: Abu-Halaweh
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control*; D010880:Piperidines / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium; D012727:Sex Characteristics
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil; D005283:Fentanyl; D000077123:Rocuronium