Pain on Injection of Rocuronium Bromide

Abstract

To the Editor: We read with interest the letter of Steegers and Robertson [1]. The authors report pain on injection of subparalyzing doses of rocuronium. We agree with the authors that injection of rocuronium can cause pain that may sometimes be severe. The factors that may affect the degree of pain are the site of injection, the dose of rocuronium, and prior administration of drugs such as midazolam, opioids, and lidocaine. We have noted that administration of midazolam, 2 mg, and fentanyl, 100 micro g, prior to rocuronium, 0.06 mg/kg, prevents the pain on injection. Steegers and Robertson suggest that rocuronium is not suitable for administration prior to succinylcholine or for priming. However, we have used rocuronium, 0.06 mg/kg, prior to succinylcholine [2] and for priming [3] without complaints of pain on injection. This suggests that, with adequate precautions, the pain on injection can be avoided. Girish P. Joshi, MBBS, MD, FFARCSI Charles W. Whitten, MD Department of Anesthesiology and Pain Management; University of Texas Southwestern Medical Center at Dallas; Dallas, TX 75235-9068