Efficacy of pretreatment with intravenous paracetamol and lidocaine on rocuronium injection pain: A randomized, double-blinded, placebo-controlled study

Background: Pain and withdrawal movement during rocuronium injection are common. The present study was conducted to compare the effect of paracetamol and lidocaine in ameliorating rocuronium injection pain and withdrawal movements. Materials and Methods: With approval of the Institutional Ethics Committee, 135 adult patients of both sexes aged 18–65 years with American Society of Anesthesiologists I or II, undergoing general anesthesia, were recruited to this randomized, double-blinded, placebo-controlled study, and patients were randomly divided into three equal groups. A rubber tourniquet was applied to the arm with intravenous line to occlude the venous drainage. Then, one of the pretreatment solutions was given, Group P received 50 mg paracetamol, Group L received 40 mg lidocaine, and Group S received 5 ml normal saline. After 2-min, tourniquet was released, and subparalyzing dose of rocuronium bromide 0.06 mg/kg was given and pain assessed using a 4-point verbal rating scale. Anesthesia was induced using 2.5% thiopentone sodium, followed by giving the remainder of calculated dose of rocuronium. During and after injection of rocuronium, withdrawal movements were observed and graded on a 4-point scale. Results: The incidence of pain on injection of subparalyzing dose of rocuronium in paracetamol, lidocaine and saline groups was 35.5%, 20%, and 55.5%, respectively (P < 0.05). The incidence of withdrawal movements while giving the bolus dose of rocuronium in paracetamol, lidocaine, and saline was 35.6%, 28.8%, and 59.9%, respectively (P < 0.05). Conclusion: Both paracetamol and lidocaine were effective in reducing rocuronium injection pain and withdrawal movements, but lidocaine is more effective than paracetamol.