Effects of pretreatment with esmolol and lidocaine on injection pain and rocuronium-induced withdrawal response

Turk J Med Sci. 2015;45(4):959-63. doi: 10.3906/sag-1311-79.

Abstract

Background/aim: We aimed to compare the effectiveness of esmolol 1 mg/kg and lidocaine 1 mg/kg for injection pain and for the prevention of rocuronium-induced withdrawal response.

Materials and methods: We enrolled a total of 81 patients in the study. Patients were randomly assigned to receive either 10 mL of 0.9% NaCl (Group P), esmolol 1 mg/kg (Group E), or lidocaine 1.0 mg/kg (Group L). A subparalyzing dose of rocuronium 0.05 mg/ kg was administered to all patients and its effects were recorded. Anesthesia was induced with intravenous propofol and intravenous rocuronium 0.5 mg/kg in all groups. The withdrawal movements of the patient groups were subsequently graded.

Results: There was a statistically significant difference in overall incidence of pain in group E and L compared to the placebo group after administrating the subparalyzed dose (no pain response: Group E = 81.5%, Group L = 77.8%, Group P = 14.8%) (P < 0.001). After intravenous administration of an intubating dose of rocuronium, the esmolol group had a significantly lower incidence of withdrawal movement than the other groups (no response: Group E = 81.5%, Group L = 63%, Group P = 22.2%) (P < 0.001).

Conclusion: We found that esmolol significantly attenuates rocuronium-induced withdrawal movement and also reduces pain when used at subparalyzing doses.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-1 Receptor Antagonists / administration & dosage
  • Adult
  • Androstanols* / administration & dosage
  • Androstanols* / adverse effects
  • Anesthesia, General / methods*
  • Anesthetics, Intravenous / administration & dosage
  • Double-Blind Method
  • Drug Monitoring
  • Female
  • Humans
  • Injections, Intravenous
  • Lidocaine / administration & dosage*
  • Male
  • Middle Aged
  • Neuromuscular Nondepolarizing Agents / administration & dosage
  • Neuromuscular Nondepolarizing Agents / adverse effects
  • Pain Measurement / methods
  • Pain* / chemically induced
  • Pain* / prevention & control
  • Propanolamines / administration & dosage*
  • Propofol / administration & dosage
  • Rocuronium
  • Substance Withdrawal Syndrome / prevention & control
  • Surgical Procedures, Operative / methods
  • Treatment Outcome

Substances

  • Adrenergic beta-1 Receptor Antagonists
  • Androstanols
  • Anesthetics, Intravenous
  • Neuromuscular Nondepolarizing Agents
  • Propanolamines
  • Lidocaine
  • esmolol
  • Rocuronium
  • Propofol