DOI: 10.1097/01.sa.0000464144.37909.5f

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Issn Print: 0039-6206

Publication Date: 2015/06/01


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Dexmedetomidine Reduces Pain Associated With Rocuronium Injection Without Causing a Decrease in BIS Values: A Dose-Response Study

Jin Joo; Jungwon Baek; Jaemin Lee

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Excerpt

Propofol and rocuronium cause pain when injected intravenously. Although dexmedetomidine has potent sedative, analgesic, and sympatholytic effects, the optimal dose and underlying mechanisms for its ability to reduce the pain associated with intravenous (IV) use of propofol and rocuronium are still unclear. This randomized, double-blind, placebo-controlled clinical comparison trial was undertaken to determine whether dexmedetomidine reduces the injection pain of propofol and rocuronium and whether such a decrease is associated with the sedative action of dexmedetomidine.
The patients were scheduled for elective surgeries under general anesthesia and were allocated to 1 of 5 groups: normal saline (saline group, n = 28), 1% lidocaine (lidocaine group, n = 28), dexmedetomidine 0.25 μg/kg, 0.5 μg/kg, or 1 μg/kg (low-dose, subclinical dose, and clinical dose groups, respectively; n = 27 in each group). Standard monitoring methods were used, and the preassigned study drug was given slowly over 2 minutes. At 60 minutes after administration of the study drug, the bispectral index (BIS) was recorded, and 50 mg propofol was injected. Pain was assessed using a 10-point scale verbal analog score (VAS). The remaining propofol dose (total 2 mg/kg) was injected. Rocuronium (0.9 mg/kg) was injected over 5 seconds, and withdrawal movements related to this injection were graded on a 4-point scale. The maximum BIS was recorded at the point of rocuronium injection and at endotracheal intubation. All data were analyzed using SigmaStat software version 2.03 (Systat, San Jose, California). P < 0.05 indicated statistical significance.
The 5 groups did not differ in demographic characteristics. The clinical-dose and low-dose dexmedetomidine groups had lower VAS scores than did the saline group at propofol injection, but this difference was not statistically significant. As the dose of dexmedetomidine increased, the 4-point withdrawal movement score after rocuronium injection decreased substantially. In the low-dose group, grades 0, 1, 2, and 3 responses were reported by 14.8%, 37.0%, 29.6%, and 13.8% of patients. Rates for the subclinical dose group were 21.4%, 35.7%, 28.6%, and 14.3%, respectively. The respective rates for the clinical dose group were 48.2%, 51.9%, 0%, and 0% for grades 0, 1, 2, and 3 withdrawal responses, respectively. The groups did not differ in BIS values at 60 seconds after drug administration or on rocuronium injection or endotracheal intubation. Immediately after arrival in the operating room and after intubation, the subclinical- and clinical-dose groups had lower heart rates than did patients in the saline or lidocaine groups. The investigators concluded that premedication with dexmedetomidine reduced the pain associated with rocuronium injection in a dose-dependent fashion, but this was not caused by the sedative action or central nervous system depression of the drug because BIS values did not change.
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