Özlem ŞEN, Dilek KALAYCI, Tülay KABAOSMAN, Menşure KAYA, Seda YILMAZ

The effect of orally administered metoprolol on the frequency and severity of rocuronium injection pain

Objectives: This study aimed to examine the effects of orally administered metoprolol on the frequency and severity of pain caused by rocuronium injection in patients who started to use and were currently using oral metoprolol for any reason such as ischemic heart disease, hypertension, and arrhythmias. Methods: Patients were evaluated in four groups. Group M: patients currently using metoprolol and who did not receive lidocaine before the application of rocuronium. Group ML: patients currently using metoprolol and who received lidocaine before rocuronium application. Group L: patients currently not using metoprolol and received lidocaine before rocuronium application. Group C: patients currently not using metoprolol and who did not receive lidocaine before rocuronium application. Following the induction of general anesthesia with thiopental sodium, a researcher blind to the groups observed the pain during rocuronium injection based on the following scale: (1) no reaction, (2) movement only in the ankle, (3) movement or withdrawal only in the arm (shoulder and ankle), and (4) diffuse reaction (movement or withdrawal in more than one extremity, coughing and holding breath). Results: Two hundred patients with 50 in each of four groups were included. The incidence of pain was statistically significantly lower in Group ML compared to Groups M and C (p = 0.001). The correlations between pain caused by rocuronium injection and duration of metoprolol usage and the time since the last dose were not statistically significant (for all, p > 0.05). Conclusions: Oral metoprolol combined with lidocaine reduced pain and withdrawal reflex caused by rocuronium injection. No significant difference was observed between the last dose and the duration of metoprolol usage.

Keywords:

Rocuronium metoprolol, lidocaine, general anesthesia, pain, reflex,

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1. Jain A, Wermuth HR, Dua A, Singh K, Maani CV.. Rocuronium. [Updated 2022 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
2. Pei DQ, Zhou HM, Zhou QH. Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia. Medicine (Baltimore) 2019;98:e13940.
3. Shimizu M, Amaya F, Kinoshita M, Yamasaki M, Yokota I, Sawa T. Reduction of the rocuronium-induced withdrawal reflex by MR13A10A, a generic rocuronium with a novel solution: a randomized, controlled study. PLoS One 2019;14:e0223947.
4. Lockey D, Coleman P. Pain during injection of rocuronium bromide. Anaesthesia 1995;50:474.
5. Mahajan C, Rath GP, Bithal PK, Prabhakar H, Yadav R, Dube SK. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth 2010;24:845-8.
6. Park KB, Jeon Y, Yi J, Kim JH, Chung SY, Kwak KH. [The effect of palonosetron on rocuronium-induced withdrawal movement]. Rev Bras Anestesiol 2017;67:337-41. [Article in Portuguese]
7. Borgeat A, Kwiatkowski D. Spontaneous movements associated with rocuronium: is pain on injection the cause? Br J Anaesth 1997;79:382-3.
8. Memis D, Turan A, Karamanlioglu B, Sut N, Pamukcu Z. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg 2002;94:1517-20.
9. Jimbo K, Itsuji Y, Kubo E, Kumagai M, Masui K, Yamamura Y. A new rocuronium formulation not causing vascular pain in a flexor reflex model of anesthetized rats. J Anesth 2018;32:806-12.
10. Jackson JL, Kuriyama A, Kuwatsuka Y, Nickoloff S, Storch D, Jackson W, et al. Beta-blockers for the prevention of headache in adults, a systematic review and meta-analysis. PLoS One 2019;14:e0212785.
11. Yavaşçaoğlu B, Kaya F, Ozcan B. Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium. J Clin Anesth 2007;19: 413-7.
12. Aşık I, Yörükoğlu D, Gulay I, Tolunay M. Pain on injection of propofol: comparison of metoprolol with lidocaine. Eur J Anaesthesiol 2003;20:487-9.
13. Steegers MA, Robertson EN. Pain on injection of rocuronium bromide. Anesth Analg 1996;83:203.
14. Blunk JA, Seifert F, Schmelz M, Reeh PW, Koppert W. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol 2003;20:245-53.
15. Hamada K, Takahashi K, Tokunaga Y, Iwasaki S, Yamakage M. Generic rocuronium reduces withdrawal movements compared to original rocuronium under target-controlled infusion induction with propofol. J Anesth 2021;35:184-8.
16. Lee YC, Jang YH, Kim JM, Lee SG. Rapid injection of rocuronium reduces withdrawal movement on injection. J Clin Anesth 2009;21:427-30.
17. Jeon Y, Baek SU, Park SS, Kim SO, Baek WY, Yeo JS. Effect of pretreatment with acetaminophen on withdrawal movements associated with injection of rocuronium: a prospective, randomized, double-blind, placebo-controlled study. Korean J Anesthesiol 2010;59:13-6.
18. Davidson EM, Doursout MF, Szmuk P, Chelly JE. Antinociceptive and cardiovascular properties of esmolol following formalin injection in rats. Can J Anaesth 2001;48:59-64.
19. Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth. 2000;84:106-7.