Efficacy of intravenous lidocaine on preventing pain/withdrawal movement associated with rocuronium injection: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Jia ¹ , CHEN Jianfeng ¹ , CUI Yu ² ,  LIU Bin ¹

1. Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Anesthesiology, Chengdu Women’s & Children’s Central Hospital, Chengdu, 610000, P.R.China;

Corresponding author：

LIU Bin, Email: liubinhx@foxmail.com

Keywords：

Rocuronium; Injection pain; Withdrawal movement; Lidocaine; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.201903100

Video：

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Objectives To systematically review the prophylactic efficacy of lidocaine administrated intravenously in advance on rocuronium associated injection pain/withdrawal movement in patients under general anesthesia.Methods PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant randomized controlled trials (RCTs) on pretreatment with lidocaine intravenously to prevent injection pain /withdraw movement from rocuronium from inception to September 30^th, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 30 RCTs involving 2 518 patients were included. The results of meta-analysis showed that, compared to the control group, pretreating with intravenous lidocaine could significantly reduced the occurrence of total pain/withdrawal movement associated with rocuronium injection (RR=0.43, 95%CI 0.36 to 0.51, P<0.000 01), and whether with (RR=0.39, 95%CI 0.29 to 0.52, P<0.000 01) or without (RR=0.45, 95%CI 0.36 to 0.57, P<0.000 01) occluding the vein, intravenous lidocaine could prevent pain/withdrawal movement associated with rocuronium injection. In addition, the incidence of lidocaine group igniting moderate (RR=0.38, 95%CI 0.31 to 0.46, P<0.000 01) or severe (RR=0.23, 95%CI 0.18 to 0.30, P<0.000 01) pain/ withdrawal movement were less likely to occur. However, there was no difference between the lidocaine and control group in the incidence of mild injection pain/withdrawal movement induced by rocuronium (RR=0.89, 95%CI 0.75 to 1.06, P=0.19).Conclusions Current evidence shows that pre-intravenous lidocaine can reduce the occurrence of injection pain/withdrawal movement associated with rocuronium injection patients, especially in the prevention of moderate and severe injection pain/withdrawal movement.

Citation： WANG Jia, CHEN Jianfeng, CUI Yu, LIU Bin. Efficacy of intravenous lidocaine on preventing pain/withdrawal movement associated with rocuronium injection: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(1): 79-86. doi: 10.7507/1672-2531.201903100 Copy

1.	Singh M, Chauhan H, Rath GP, et al. Effect of narcotic pretreatment on pain after rocuronium injection: a randomized, double-blind controlled comparison with lidocaine. J Anesth, 2007, 21(4): 510-512.
2.	魏闯, 段礼平, 彭庆, 等. 舒芬太尼, 芬太尼和利多卡因预防儿童静脉注射罗库溴铵回缩反应研究. 四川医学, 2009, 30(12): 1885-1886.
3.	Shevchenko Y, Jocson JC, McRae VA, et al. The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents. Anesth Analg, 1999, 88(4): 746-748.
4.	Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth, 2000, 84(1): 106-107.
5.	Memis D, Turan A, Karamanlioğlu B, et al. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
6.	Ahmad N, Choy CY, Aris EA, et al. Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine. Anesth Analg, 2005, 100(4): 987-990.
7.	Ertugrul F. A comparison of the efficacies of different pre-treatment drugs in resolving the injection pain of rocuronium. J Int Med Res, 2006, 34(6): 665-670.
8.	Kim KS, Kim YS, Jeon WJ, et al. Prevention of withdrawal associated with the injection of rocuronium in adults and children. J Clin Anesth, 2006, 18(5): 334-338.
9.	曾婉华, 欧阳葆怡. 利多卡因, 曲马多和枢复宁对预防罗库溴铵注药痛的对比研究. 海南医学, 2005, (8): 30-32.
10.	陆敏霞, 叶素娟. 利多卡因, 芬太尼, 曲马多减轻罗库溴铵注射痛效果比较. 山东医药, 2007, (23): 79.
11.	张永俊, 洪涛, 廖建文. 芬太尼和利多卡因减轻罗库溴铵注射痛的效果. 江苏医药, 2008, (9): 938-939.
12.	曾洪友, 曾思. 不同剂量利多卡因预处理对罗库溴铵注射痛的影响. 华西医学, 2010, 25(8): 1527-1529.
13.	Zhang Y, Xiang Y, Liu J. Prevention of pain on injection of rocuronium: a comparison of lidocaine with different doses of parecoxib. J Clin Anesth, 2012, 24(6): 456-459.
14.	张晗, 刘进. 预注射利多卡因与局部加温缓解罗库溴铵注射痛的比较. 华西医学, 2012, 27(5): 707-710.
15.	Jeon Y, Ha JH, Lee JE, et al. Rocuronium-induced withdrawal movement: influence of ketorolac or a combination of lidocaine and ketorolac pretreatment. Korean J Anesthesiol, 2013, 64(1): 25-28.
16.	朱琳佳, 桂波, 倪燕, 等. 不同剂量利多卡因对罗库溴铵静脉注射痛及诱导期心血管反应的影响. 临床麻醉学杂志, 2013, 26(4): 336-338.
17.	Abu-Halaweh SA, Aloweidi AK, Qudaisat IY, et al. Pretreatment with remifentanil, fentanyl, or lidocaine to prevent withdrawal after rocuronium using venous occlusion technique in children and adolescents: a prospective randomized placebo-controlled double-blind study. J Anesth, 2014, 28(6): 886-890.
18.	曾思, 温开兰, 蔡兵, 等. 预先静脉注射右美托咪定与利多卡因对罗库溴铵注射痛的影响. 国际麻醉学与复苏杂志, 2014, 35(5): 401-404.
19.	邝立挺, 张涛, 修欢欢, 等. 帕洛诺司琼与利多卡因预处理用于减轻罗库溴铵静脉注射痛的研究. 医学理论与实践, 2014, 27(19): 2536-2537.
20.	李莎, 田伟千, 季方兵, 等. 氟比洛芬酯复合利多卡因联合止血带对罗库溴铵注射痛的影响. 临床麻醉学杂志, 2014, 30(5): 469-471.
21.	柯炜. 格拉司琼复合利多卡因预注对罗库溴铵注射痛的影响. 江西医药, 2018, 53(7): 96-97, 109.
22.	余亮, 吴锋锋, 刘洋. 格拉司琼预处理对罗库溴铵注射痛和体动反应的影响. 中国新药与临床杂志, 2018, 37(2): 107-110.
23.	陈鸿武, 陈琳莉, 黄慧青, 等. 不同药物预防罗库溴铵注药痛临床效果研究. 泰山医学院报, 2014, 35(12): 1223-1226.
24.	王红珠, 王军会, 王惠琴. 昂丹司琼复合利多卡因预防罗库溴铵注射痛临床分析. 中国药物与临床, 2010, 10(12): 1410-1411.
25.	Ayoğlu H, Altunkaya H, Ozer Y, et al. Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? Eur J Anaesthesiol, 2007, 24(6): 541-545.
26.	Yavascaoglu B, Kaya FN, Ozcan B. Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium. J Clin Anesth, 2007, 19(6): 413-417.
27.	Lee YC, Jang YH, Kim JM, et al. Rapid injection of rocuronium reduces withdrawal movement on injection. J Clin Anesth, 2009, 21(6): 427-430.
28.	Akcaboy ZN, Akcaboy EY, Soyal OB, et al. Can ephedrine pretreatment be effective in alleviating rocuronium injection pain? Med Princ Pract, 2012, 21(4): 323-327.
29.	Choi YJ, Park HS, Lee H, et al. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol, 2012, 63(5): 413-418.
30.	Kim E, Kim CH, Kim HK, et al. Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection. J Anesth, 2013, 27(6): 868-873.
31.	Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology, 1993, 79(5): 913-918.
32.	Martin R, Carrier J, Pirlet M, et al. Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia. Can J Anaesth, 1998, 45(6): 521-525.
33.	Kim DH, Roh GU, Lee YB, et al. Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial. Ther Clin Risk Manag, 2018, 14: 189-194.
34.	Prabhakar H, Singh GP, Ali Z, et al. Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults. Cochrane Database Syst Rev, 2016, (2): CD009346.
35.	张永强, 时娟, 李鑫, 等. 不同干预措施预防罗库溴铵注射相关疼痛/缩肢反应有效性的Meta分析. 中国循证医学志, 2016, 16(2): 172-182.
36.	Jimbo K, Itsuji Y, Kubo E, et al. A new rocuronium formulation not causing vascular pain in a flexor reflex model of anesthetized rats. J Anesth, 2018, 32(6): 806-812.
37.	Blunk JA, Seifert F, Schmelz M, et al. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol, 2003, 20(3): 245-253.
38.	Baek SB, Shin MS, Han JH, et al. Rocuronium bromide inhibits inflammation and pain by suppressing nitric oxide production and enhancing prostaglandin E2 synthesis in endothelial cells. Int Neurourol J, 2016, 20(4): 296-303.
39.	Lee HJ, Kim KS, Yeon JT, et al. Potency and recovery characteristics of rocuronium mixed with sodium bicarbonate. Anaesthesia, 2010, 65(9): 899-903.
40.	Mahajan C, Rath GP, Bithal PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth, 2010, 24(6): 845-848.
41.	Kim JH, Kim JH, Han SH, et al. Alfentanil is comparable to remifentanil in preventing withdrawal movement following rocuronium injection. J Clin Anesth, 2009, 21(1): 9-12.
42.	Ates G, Kose EA, Oz G, et al. Effect of paracetamol pretreatment on rocuronium-induced injection pain: a randomized, double-blind, placebo-controlled comparison with lidocaine. J Clin Analy Med, 2014, 5(6): 507-510.
43.	He Q, Zhou C, Zhu Y. The effect of 5-hydroxytryptamine receptor antagonist in preventing pain/limb shrinkage reaction associated with rocuronium injection. Biomed Res Int, 2018, 2018: 4128415.
44.	Benowitz NL, Meister W. Clinical pharmacokinetics of lignocaine. Clin Pharmacokinet, 1978, 3(3): 177-201.
45.	Duff JP, Topjian A, Berg MD, et al. 2018 American heart association focused update on pediatric advanced life support: an update to the American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2018, 138(23): e731-e739.
46.	Hashemian AM, Zamani Moghadam Doloo H, Saadatfar M, et al. Effects of intravenous administration of fentanyl and lidocaine on hemodynamic responses following endotracheal intubation. Am J Emerg Med, 2018, 36(2): 197-201.
47.	Lin CS, Sun WZ, Chan WH, et al. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough. Can J Anaesth, 2004, 51(7): 654-659.

1. Singh M, Chauhan H, Rath GP, et al. Effect of narcotic pretreatment on pain after rocuronium injection: a randomized, double-blind controlled comparison with lidocaine. J Anesth, 2007, 21(4): 510-512.
2. 魏闯, 段礼平, 彭庆, 等. 舒芬太尼, 芬太尼和利多卡因预防儿童静脉注射罗库溴铵回缩反应研究. 四川医学, 2009, 30(12): 1885-1886.
3. Shevchenko Y, Jocson JC, McRae VA, et al. The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents. Anesth Analg, 1999, 88(4): 746-748.
4. Cheong KF, Wong WH. Pain on injection of rocuronium: influence of two doses of lidocaine pretreatment. Br J Anaesth, 2000, 84(1): 106-107.
5. Memis D, Turan A, Karamanlioğlu B, et al. The prevention of pain from injection of rocuronium by ondansetron, lidocaine, tramadol, and fentanyl. Anesth Analg, 2002, 94(6): 1517-1520.
6. Ahmad N, Choy CY, Aris EA, et al. Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine. Anesth Analg, 2005, 100(4): 987-990.
7. Ertugrul F. A comparison of the efficacies of different pre-treatment drugs in resolving the injection pain of rocuronium. J Int Med Res, 2006, 34(6): 665-670.
8. Kim KS, Kim YS, Jeon WJ, et al. Prevention of withdrawal associated with the injection of rocuronium in adults and children. J Clin Anesth, 2006, 18(5): 334-338.
9. 曾婉华, 欧阳葆怡. 利多卡因, 曲马多和枢复宁对预防罗库溴铵注药痛的对比研究. 海南医学, 2005, (8): 30-32.
10. 陆敏霞, 叶素娟. 利多卡因, 芬太尼, 曲马多减轻罗库溴铵注射痛效果比较. 山东医药, 2007, (23): 79.
11. 张永俊, 洪涛, 廖建文. 芬太尼和利多卡因减轻罗库溴铵注射痛的效果. 江苏医药, 2008, (9): 938-939.
12. 曾洪友, 曾思. 不同剂量利多卡因预处理对罗库溴铵注射痛的影响. 华西医学, 2010, 25(8): 1527-1529.
13. Zhang Y, Xiang Y, Liu J. Prevention of pain on injection of rocuronium: a comparison of lidocaine with different doses of parecoxib. J Clin Anesth, 2012, 24(6): 456-459.
14. 张晗, 刘进. 预注射利多卡因与局部加温缓解罗库溴铵注射痛的比较. 华西医学, 2012, 27(5): 707-710.
15. Jeon Y, Ha JH, Lee JE, et al. Rocuronium-induced withdrawal movement: influence of ketorolac or a combination of lidocaine and ketorolac pretreatment. Korean J Anesthesiol, 2013, 64(1): 25-28.
16. 朱琳佳, 桂波, 倪燕, 等. 不同剂量利多卡因对罗库溴铵静脉注射痛及诱导期心血管反应的影响. 临床麻醉学杂志, 2013, 26(4): 336-338.
17. Abu-Halaweh SA, Aloweidi AK, Qudaisat IY, et al. Pretreatment with remifentanil, fentanyl, or lidocaine to prevent withdrawal after rocuronium using venous occlusion technique in children and adolescents: a prospective randomized placebo-controlled double-blind study. J Anesth, 2014, 28(6): 886-890.
18. 曾思, 温开兰, 蔡兵, 等. 预先静脉注射右美托咪定与利多卡因对罗库溴铵注射痛的影响. 国际麻醉学与复苏杂志, 2014, 35(5): 401-404.
19. 邝立挺, 张涛, 修欢欢, 等. 帕洛诺司琼与利多卡因预处理用于减轻罗库溴铵静脉注射痛的研究. 医学理论与实践, 2014, 27(19): 2536-2537.
20. 李莎, 田伟千, 季方兵, 等. 氟比洛芬酯复合利多卡因联合止血带对罗库溴铵注射痛的影响. 临床麻醉学杂志, 2014, 30(5): 469-471.
21. 柯炜. 格拉司琼复合利多卡因预注对罗库溴铵注射痛的影响. 江西医药, 2018, 53(7): 96-97, 109.
22. 余亮, 吴锋锋, 刘洋. 格拉司琼预处理对罗库溴铵注射痛和体动反应的影响. 中国新药与临床杂志, 2018, 37(2): 107-110.
23. 陈鸿武, 陈琳莉, 黄慧青, 等. 不同药物预防罗库溴铵注药痛临床效果研究. 泰山医学院报, 2014, 35(12): 1223-1226.
24. 王红珠, 王军会, 王惠琴. 昂丹司琼复合利多卡因预防罗库溴铵注射痛临床分析. 中国药物与临床, 2010, 10(12): 1410-1411.
25. Ayoğlu H, Altunkaya H, Ozer Y, et al. Does dexmedetomidine reduce the injection pain due to propofol and rocuronium? Eur J Anaesthesiol, 2007, 24(6): 541-545.
26. Yavascaoglu B, Kaya FN, Ozcan B. Esmolol pretreatment reduces the frequency and severity of pain on injection of rocuronium. J Clin Anesth, 2007, 19(6): 413-417.
27. Lee YC, Jang YH, Kim JM, et al. Rapid injection of rocuronium reduces withdrawal movement on injection. J Clin Anesth, 2009, 21(6): 427-430.
28. Akcaboy ZN, Akcaboy EY, Soyal OB, et al. Can ephedrine pretreatment be effective in alleviating rocuronium injection pain? Med Princ Pract, 2012, 21(4): 323-327.
29. Choi YJ, Park HS, Lee H, et al. Single pretreatment of remifentanil may reduce pain after propofol and rocuronium injection in rapid sequence induction. Korean J Anesthesiol, 2012, 63(5): 413-418.
30. Kim E, Kim CH, Kim HK, et al. Effect of nitrous oxide inhalation on pain after propofol and rocuronium injection. J Anesth, 2013, 27(6): 868-873.
31. Magorian T, Flannery KB, Miller RD. Comparison of rocuronium, succinylcholine, and vecuronium for rapid-sequence induction of anesthesia in adult patients. Anesthesiology, 1993, 79(5): 913-918.
32. Martin R, Carrier J, Pirlet M, et al. Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia. Can J Anaesth, 1998, 45(6): 521-525.
33. Kim DH, Roh GU, Lee YB, et al. Prediction of emergence agitation using withdrawal reaction following rocuronium injection in preschool-aged patients undergoing inguinal herniorrhaphy: a preliminary exploratory observational trial. Ther Clin Risk Manag, 2018, 14: 189-194.
34. Prabhakar H, Singh GP, Ali Z, et al. Pharmacological and non-pharmacological interventions for reducing rocuronium bromide induced pain on injection in children and adults. Cochrane Database Syst Rev, 2016, (2): CD009346.
35. 张永强, 时娟, 李鑫, 等. 不同干预措施预防罗库溴铵注射相关疼痛/缩肢反应有效性的Meta分析. 中国循证医学志, 2016, 16(2): 172-182.
36. Jimbo K, Itsuji Y, Kubo E, et al. A new rocuronium formulation not causing vascular pain in a flexor reflex model of anesthetized rats. J Anesth, 2018, 32(6): 806-812.
37. Blunk JA, Seifert F, Schmelz M, et al. Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings. Eur J Anaesthesiol, 2003, 20(3): 245-253.
38. Baek SB, Shin MS, Han JH, et al. Rocuronium bromide inhibits inflammation and pain by suppressing nitric oxide production and enhancing prostaglandin E2 synthesis in endothelial cells. Int Neurourol J, 2016, 20(4): 296-303.
39. Lee HJ, Kim KS, Yeon JT, et al. Potency and recovery characteristics of rocuronium mixed with sodium bicarbonate. Anaesthesia, 2010, 65(9): 899-903.
40. Mahajan C, Rath GP, Bithal PK, et al. Local warming at injection site helps alleviate pain after rocuronium administration. J Anesth, 2010, 24(6): 845-848.
41. Kim JH, Kim JH, Han SH, et al. Alfentanil is comparable to remifentanil in preventing withdrawal movement following rocuronium injection. J Clin Anesth, 2009, 21(1): 9-12.
42. Ates G, Kose EA, Oz G, et al. Effect of paracetamol pretreatment on rocuronium-induced injection pain: a randomized, double-blind, placebo-controlled comparison with lidocaine. J Clin Analy Med, 2014, 5(6): 507-510.
43. He Q, Zhou C, Zhu Y. The effect of 5-hydroxytryptamine receptor antagonist in preventing pain/limb shrinkage reaction associated with rocuronium injection. Biomed Res Int, 2018, 2018: 4128415.
44. Benowitz NL, Meister W. Clinical pharmacokinetics of lignocaine. Clin Pharmacokinet, 1978, 3(3): 177-201.
45. Duff JP, Topjian A, Berg MD, et al. 2018 American heart association focused update on pediatric advanced life support: an update to the American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2018, 138(23): e731-e739.
46. Hashemian AM, Zamani Moghadam Doloo H, Saadatfar M, et al. Effects of intravenous administration of fentanyl and lidocaine on hemodynamic responses following endotracheal intubation. Am J Emerg Med, 2018, 36(2): 197-201.
47. Lin CS, Sun WZ, Chan WH, et al. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough. Can J Anaesth, 2004, 51(7): 654-659.

Chinese Journal of Evidence-Based Medicine

Efficacy of intravenous lidocaine on preventing pain/withdrawal movement associated with rocuronium injection: a meta-analysis

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