comparison of granisetron and nitroglycerine for attenuating rocuronium pain: a double-blinded randomized, placebo controlled trial

ABSTRACT

The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain. One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading [ASA] I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G received 2 granisetron [1mg/ml] diluted with 3 ml of 0.9% normal saline] while the Group C received 5 ml of 0.9% normal saline. Group N received 200 micro g of nitroglycerine diluted to a total of 5 ml[with 0.9% normal saline]. It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec.Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale [0-10] with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement [grade 0], movement only wrist [grade 1], movement to the upper arm and shoulder of injected arm [grade 2] or generalized movements [grade3] was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done. 1. At 0 seconds, in group G number of patients who experienced with drawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable with drawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48% of patients had VAS score of 2-3. We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain