Effectiveness and safety of rocuronium or nitroglycerin plus ropivacaine on pain during intravenous regional anesthesia: A double–blind randomized controlled trial

Abstract

Objective: To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia (IVRA) on pain and hemodynamic parameters. Methods: This randomized controlled trial was done in 2023. Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital, Arak, Iran. They were allocated by block randomization to three different groups, namely nitroglycerin group, rocuronium group and control group. Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time. Sensory block and motor block onset and duration and pain were also evaluated. The data analysis was carried out by IMB SPSS software 20.0. Results: 177 Eligible patients were included in study, with 59 in each group. Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups (P<0.001). Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness. The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups (P=0.009). Conclusions: Nitroglycerin significantly reduces the time to sensory and motor block onset, while rocuronium is more effective in prolonging the time of motor block. Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration, nitroglycerin is associated with a higher prevalence of medication side effects. Therefore, both nitroglycerin and rocuronium can be used as adjuvant for IVRA. The final choice relies on patients’ conditions and anesthesiologists’ judgment.

Keywords

• rocuronium
• nitroglycerin
• ropivacaine
• pain
• hemodynamic
• regional anesthesia
• intravenous anesthesia