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Injection pain of rocuronium and vecuronium is evoked by direct activation of nociceptive nerve endings

Published online by Cambridge University Press:  02 June 2005

J. A. Blunk ,
F. Seifert ,
M. Schmelz ,
P. W. Reeh  and
W. Koppert
J. A. Blunk
Affiliation:
Friedrich-Alexander University, Department of Anaesthesiology, Erlangen, Germany
F. Seifert
Affiliation:
Friedrich-Alexander University, Department of Physiology and Experimental Pathophysiology, Erlangen, Germany
M. Schmelz
Affiliation:
Friedrich-Alexander University, Department of Physiology and Experimental Pathophysiology, Erlangen, Germany
P. W. Reeh
Affiliation:
Friedrich-Alexander University, Department of Physiology and Experimental Pathophysiology, Erlangen, Germany
W. Koppert
Affiliation:
Friedrich-Alexander University, Department of Anaesthesiology, Erlangen, Germany
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Extract

Summary

Background and objective: Rocuronium and, to a lesser extent, vecuronium can induce burning sensations associated with withdrawal reactions during administration. Dermal microdialysis in human and electrophysiological recordings of nociceptors in mouse skin were used to elucidate the underlying mechanisms of pain induction.

Methods: Microdialysis catheters were inserted intradermally into the forearm of 10 volunteers and were perfused with two different concentrations of rocuronium and vecuronium (1 and 10 mg mL−1) or a control. Dialysis samples were taken every 15 min and analysed for protein, histamine, tryptase and bradykinin content. Pain intensity was rated on a numerical scale of 0–10. In a parallel design, activation of cutaneous nociceptors was assessed directly in a skin–nerve in vitro preparation of the mouse hind paw. The receptive fields of identified single C-nociceptors (n = 12) were superfused with rocuronium or vecuronium solutions (10 mg mL−1) at physiological pH.

Results: In accordance with clinical observations, microdialysis of rocuronium (10 mg mL−1) induced sharp burning pain (NRS 4.1 ± 1.8), whereas vecuronium given in the usual clinical concentration (1 mg mL−1) induced only minor pain sensations (NRS 0.6 ± 1.3). At equimolar concentrations, pain sensation and concomitant mediator release evoked by both drugs were similar. No correlations were found between pain rating and mediator release. In the in vitro preparation, C-fibres showed a consistent excitatory response with rapid onset after stimulation with vecuronium as well as rocuronium (differences not significant).

Conclusions: The algogenic effect of aminosteroidal neuromuscular blocking drugs can be attributed to a direct activation of C-nociceptors.

Keywords

NEUROMUSCULAR-BLOCKING AGENTS, vecuronium bromide, rocuronium bromidePERIPHERAL NERVOUS SYSTEM, nociceptorsPSYCHOPHYSIOLOGY, pain
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 3 , March 2003 , pp. 245 - 253
Copyright
© 2003 European Society of Anaesthesiology

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