title: Prevention of Withdrawal Movement Associated with the Injection of Rocuronium in Children: Comparison of Paracetamol and Lidocaine.
abstract: OBJECTIVE
  Pain from rocuronium injection is observed in 50%-80 % of patients. This study aimed to compare the effectiveness of pretreatment with paracetamol and lidocaine in preventing pain-induced withdrawal caused by the intravenous injection of rocuronium during the induction of general anaesthesia in paediatric patients.
  
  
  METHODS
  Ninety children were randomized into two groups using a simple drawing from the box method: a paracetamol group (Group P, n=45) and a lidocaine group (Group L, n=45). After anaesthesia induction, venous occlusion was applied by a paediatric cuff inflated to a pressure of 75 mmHg and by 50 mg paracetamol and 0.5 mg kg(-1) lidocaine was injected in Groups P and L, respectively. Venous occlusion was then released, followed by rocuronium injection (0.6 mg kg(-1)). Withdrawal was evaluated using a 4-point scale (1, no response; 2, movement at the wrist only; 3, movement/withdrawal involving arm only (elbow/shoulder) and 4, generalized response, movement/withdrawal in more than one extremity).
  
  
  RESULTS
  The incidence of withdrawal movement was 42% and 26% in the Groups P and L, respectively (p=0.120). Although no significant differences were noted in the number of patients who had no withdrawal movement and mild withdrawal movement in Groups P and L, compared with Group L, the incidences of moderate withdrawal movement were significantly higher in Group P (p<0.05). No patient in either group revealed generalized movement.
  
  
  CONCLUSIONS
  Using a venous occlusion technique, pretreatment with 50 mg paracetamol can prevent withdrawal movement caused by rocuronium injection in children but is not as effective as lidocaine to prevent moderate withdrawal movement.
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Polat
authors.affiliation: Clinic of Anaesthesia, Ankara Pediatrics Haematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Mine
authors.initials: M
authors.lastname: Akın
authors.affiliation: Clinic of Anaesthesia, Ankara Pediatrics Haematology Oncology Training and Research Hospital, Ankara, Turkey.
authors.forename: Gülsen
authors.initials: G
authors.lastname: Keskin
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Ünal
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
authors.forename: Aslı
authors.initials: A
authors.lastname: Dönmez
keywords: Rocuronium; lidocaine; paracetamol; withdrawal movement