Comparison of pretreatment with lidocaine, esmolol, and ketorolac in controlling rocuronium injection-induced pain: A randomized clinical trial

Abstract

Background: Rocuronium injection pain is a common side effect during anesthesia induction, causing patient dissatisfaction and rocuronium injection withdrawal movement, putting the patient at risk for serious complications. Objective: This study aims to compare the effectiveness and safety profile of esmolol, ketorolac, lidocaine, and placebo in a controlled randomized trial to establish the drug of choice, elevate patient satisfaction, and reduce perioperative adverse effects. Materials and Methods: About 176 patients were enrolled in the study and were randomly assigned to four groups; receiving pretreatment with 2 mL of 0.9% sodium chloride (group P), 1 mg/kg of lidocaine (group L), 10 mg of ketorolac (group K), and 0.5 mg/kg of esmolol (group S). Two minutes after the study drug infusion, 0.3 mg/kg of 1% rocuronium was injected. Pain was documented with the visual analog scale during and 1 min after rocuronium injection. Heart rate, blood pressure, and oxygen saturation were recorded multiple times during and after the operation. Results: The four groups showed significant differences in pain score (P < 0.001) with the least severe pain experienced in the esmolol group both during and 1 min after rocuronium injection. The mean heart rate was significantly lower in the esmolol group 20 (P = 0.03) and 30 (P = 0.03) min after surgery. Conclusion: Pretreatment with esmolol is effective in reducing pain on rocuronium injection and its subsequent effects, and despite causing bradycardia, a manageable side effect, esmolol has an otherwise acceptable safety profile. Hence, esmolol can be a favorable choice in reducing pain caused by rocuronium injection.

Keywords

• esmolol
• ketorolac
• lidocaine
• riwm
• rocuronium injection-induced pain