Effects of Pretreatment with Lidocaine or Ketamine on Injection Pain and Withdrawal Movements of Rocuronium

Aims: The incidence and severity of pain on injection of rocuronium and its pretreatment with saline, lidocaine or ketamine were evaluated. Materials and Methods: One hundred and twenty patients were randomized into three groups to receive intravenous (i.v.) lidocaine 30 mg (Group Lidocaine, n=40), ketamine 0.5 mg/kg (Group Ketamine, n=40) or saline 2 ml (Group Saline, n=40). Thirty seconds after the pretreatment drug, intubation dose of rocuronium (0.6 mg/kg) was injected by i.v. route in 5 seconds. The pain and the withdrawal movements were assessed by a five-point and a four-point scale, respectively. Six hours after anesthesia, patients were asked whether they recalled pain in the arm during induction of anesthesia. Results: The incidence of pain response after rocuronium injection (grade 2 or more) was 82.5%, 12.5% and 62.5% in saline, lidocaine and ketamine groups, respectively. The median pain score in Group Lidocaine was significantly lower than those of groups Ketamine and Saline (P < 0.001). The incidence of withdrawal movements was 32.5%, 2.5% and 15% in the saline, lidocaine and ketamine groups, respectively. The median withdrawal movement score was significantly lower only in Group Lidocaine compared to Group Saline (P=0.011). There was no difference in reported pain or withdrawal movements between men and women. Conclusions: For decreasing the severity of pain and withdrawal movements induced by rocuronium injection, lidocaine is more effective when compared with ketamine.