Effect of narcotic pretreatment on pain after rocuronium injection: a randomized, double-blind controlled comparison with lidocaine

Various strategies have been studied to reduce the discomfort of rocuronium pain. These studies have shown fentanyl and lidocaine to be effective in reducing the incidence of pain on rocuronium injection. This prospective, randomized, and double-blind study was carried out on 80 neurosurgical patients for whom pain on rocuronium injection was assessed after pretreatment with lidocaine, fentanyl, sufentanil, or normal saline. The 80 neurosurgical patients were randomly allocated to anyone of the groups to receive lidocaine, fentanyl, sufentanil, or normal saline prior to being given rocuronium. The patients were asked about any discomfort in the hand, and also to rank that discomfort on a 5-point scale. In the normal saline group, the incidence of pain was 95%, of which 90% had very severe pain. In the lidocaine group, only 10% of patients reported pain, which was mild in nature. In the fentanyl group, 95% of patients had pain, of whom 25% had severe to very severe pain. In the sufentanil group, 85% of patients reported pain, of whom 25% fell into the severe to very severe group. We found that lidocaine was best at decreasing the incidence of pain on intravenous (i.v.) injection of rocuronium. Although the incidence of pain on injection of rocuronium with both fentanyl and sufentanil was high, the intensity was definitely reduced, with most patients falling in the mild pain group.