Pain on Injection of Rocuronium Bromide

Abstract

To the Editor: Rocuronium is a new, nondepolarizing muscle relaxant [1]. We have noticed that patients complain of severe burning pain if rocuronium is administered before loss of consciousness after induction of anesthesia or using a priming principle wherein a small subparalyzing dose (10% of an intubating dose) of the relaxant can be administered followed by the larger, remaining portion of the relaxant after administration of the induction drug. Most of the patients who received rocuronium before loss of consciousness after induction with barbiturates or other drugs complained of severe burning pain in their vein and arm. Rocuronium is supplied in a sterile, nonpyrogenic, isotonic solution. The isotonicity is obtained using sodium chloride, and the pH of 4 is achieved by adding acetic acid or sodium hydroxide [2]. The pain can be decreased by prior administration of intravenous lidocaine. Rocuronium produces a burning pain in the vein or arm if administered before the loss of consciousness after induction of anesthesia. Prior administration of lidocaine may reduce the pain. Otherwise, rocuronium should be administered after induction of anesthesia and loss of consciousness. S. S. Moorthy, MD Stephen F. Dierdorf, MD Department of Anesthesia, Indiana University School of Medicine, Indianapolis, IN 46202-5115