Rocuronium Injection Pain is Attenuated by NaHCO3 / 대한마취과학회지

BACKGROUND: Rocuronium administration is associated with a severe burning pain during injection. However, the mechanistic cause of the pain has not been well established. The purpose of this study was to determine whether adjusting the pH of the rocuronium with NaHCO3 would ameliorate the pain. METHODS: We examined mixtures using microscope after NaHCO3 was mixed with rocuronium to exam solubility. Sixty of 80 patients scheduled for elective gynecologic surgery were randomly allocated to one of three groups as follows: group 1 (rocuronium only, n = 20), group 2 (rocuronium 50 mg/5 ml mixed with 0.9% NaCl 3 ml, n = 20), group 3 (rocuronium 50 mg/5 ml mixed with NaHCO3 3 ml, n = 20). All patients received 0.6 mg/kg of rocuronium over 10 sec and were asked to assess pain using a visual analogue scale (VAS) followed by injection of propofol 1.5 mg/kg and fentanyl 100 mcg. The onset and duration of rocuronium were measured in three groups. Twitch responses to cumulative incremental doses of rocuronium were measured in another 20 patients, allocated to group A (rocuronium only, n = 10) or group B (rocuronium 50 mg/5 ml mixed with NaHCO3 3 ml, n = 10). RESULTS: Over 24 hours, no precipitation or particles were found after mixing NaHCO3 with rocuronium. The VAS was significantly lower in group 3 (0.5+/-0.9) than in group 1 (5.4+/-3.2) or in group 2 (4.9+/-2.1) (P < 0.05). Eighteen of 20 patients in group 3 had no pain and only 2 had mild pain, but all patients in groups 1 and 2 had mild to severe pain. There were no differences in onset or duration between the three groups and in twitch responses between group A and B. CONCLUSIONS: NaHCO3 mixed with rocuronium attenuates rocuronium injection pain, and there were no problems or complications.

Effect of Greater Occipital Nerve Block on the Posterior Headache and Neck Pain after Total Thyroidectomy / 대한마취과학회지

BACKGROUND: During thyroidectomy, the patient's neck is fully extended for good surgical exposure. After thyroidectomy, patients usually complain of posterior headache and posterior neck pain. It has been known that the greater occipital nerve block is a means of effective medical treatment for occipital headache and posterior neck pain. Therefore, we examined the effects of a greater occipital nerve block on postthyroidectomy headache and neck pain. METHODS: This study was randomized and double-blinded. After anesthesia induction, patients were administered greater occipital nerve block by the same anesthesiologist; 0.25% bupivacaine 5 ml was used for each greater occipital nerve block. Patients in the control group did not receive a greater occipital nerve block. After thyroidectomy, another anesthesiologist evaluated patients' headaches and neck pains at 4, 12, and 24 hours postoperatively by using a VAS. RESULTS: Forty four patients were included. The number of patients in the control and the block group were 27 and 17, respectively. VAS scores of occipital headache after 4, 12, and 24 hours in the control group were 3.52+/-2.75, 3.67+/-2.75, and 2.95+/-1.96, respectively. VAS scores of occipital headache after 4, 12, and 24 hours in the block group were 0.05+/-0.65, 0.50+/-0.85, and 0.43+/-0.64, respectively. VAS scores of posterior neck pain after 4, 12, and 24 hours in the control group were 4.09+/-2.79, 3.81+/-2.60, and 3.00+/-2.02. VAS scores of posterior neck pain after 4, 12, and 24 hours in the block group were 1.29+/-2.20, 1.00+/-1.66, and 0.79+/-1.25, respectively. The pain experienced by the block group was significantly lower than that of the control group. CONCLUSIONS: We conclude that greater occipital nerve block is an effective modality for reducing post-thyroidectomy headache and posterior neck pain.