25. Pharmacological and non-pharmacological interventions for reducing pain on rocuronium injection – A systematic review

 

 Permissions and Reprints

Background: Various strategies, both pharmacological and non-pharmacological, have been studied to reduce the discomfort, incidence and severity of pain on rocuronium bromide injection. The objective of this review was to assess the ability of both pharmacological and non-pharmacological interventions designed to reduce or eliminate the pain that accompanies rocuronium bromide administration, both in adults and children, whether in asleep or awake state. Materials and Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid SP (1966 to December 2012), and EMBASE via Ovid SP (1980 to December 2012). We included all randomized controlled trials (RCTs) that compared the use of any drug or a non-pharmacological method with control patients, or those receiving no treatment to reduce the severity of pain with rocuronium injection. Our primary outcome was pain on rocuronium bromide injection measured by a pain score assessment. Our secondary outcomes were rise in heart rate and blood pressure following administration of rocuronium and adverse events related to the interventions. We used the standardized methods for conducting a systematic review as described by the Cochrane handbook for Systematic Reviews of Interventions. Two authors independently extracted details of trial methodology and outcome data from reports of all trials considered eligible for inclusion. All analyses were made on intention-to-treat basis. We used a fixed-effect model where there was no evidence of significant heterogeneity between studies and a random-effects model if heterogeneity was likely. Results: We included 66 studies with 8621 participants in the review, though most analyses were based on data from fewer participants. We noted substantial heterogeneity between trials. Therefore, it was not possible to combine the trials for the outcomes. All studies reported the primary outcome pain; few studies reported adverse events and no study reported heart rate and blood pressure changes after administration of rocuronium. Conclusion: Lidocaine was the most popular intervention drug used in 29 trials with 2256 participants. The relative risk (RR) of pain on injection if given lignocaine compared to placebo was 0.21; 95% CI 0.16 to 0.29. Adverse events were reported mainly with use of opioids. They were cough, breath holding and chest tightness. The overall rate of complications was low. Both pharmacological and non-pharmacological methods were effective in reducing pain on injection of rocuronium. However, no one intervention can be considered superior over the other as the findings are not robust enough.