Pain on Injection of Rocuronium Bromide

Abstract

In Response: Thank you for the opportunity to reply to the comments of Drs. Joshi and Whitten. Our small study [1] clearly demonstrated that even small doses of rocuronium cause pain on injection in awake patients and that the pain can be severe. This pain was also not related to the site of injection. In the only reference that could be checked by us [2], the authors suggest that the administration of midazolam 2 mg and fentanyl 100 micro g before rocuronium will prevent the pain on injection. Unfortunately, these authors also had given their patients 2 mg/kg propofol and were maintaining their anesthesia with nitrous oxide 70% and 0.5%-1.5% isoflurane when their subparalyzing dose of rocuronium was given. It is hardly surprising that they have not observed "complaints of pain on injection"! Our suggestion then, that rocuronium is probably unsuitable for injection in awake patients, remains unaltered. Monique Steegers, MD Eric Robertson, FRCA Department of Anesthesiology; Academisch Ziekenhuis Nijmegen; Nijmegen, The Netherlands