The use of lidocaine for preventing the withdrawal associated with the injection of rocuronium in children and adolescents

We designed this study to examine the incidence and degree of movement after the administration of rocuronium in children and adolescents and to measure the treatment effect of lidocaine for its prevention. One hundred patients (aged 5-18 yr) were randomly assigned to two groups. After general anesthesia was induced with 5 mg/kg thiopental sodium and manual occlusion of venous outflow was performed, one group of patients received 0.1 mL/kg 1% lidocaine IV. A second group received 0.1 mL/kg of isotonic sodium chloride solution as a placebo control. Venous outflow occlusion was held for 15 s, released, and immediately followed by the administration of rocuronium 1 mg/kg IV. The patient's response to rocuronium injection was graded using a 4-point scale. We observed that the incidence of withdrawal was 84% in the placebo group and was significantly decreased to 46% in patients pretreated with lidocaine (P < 0.001). This study demonstrates that the IV injection of rocuronium is commonly associated with a withdrawal reaction in anesthetized pediatric patients and that this reaction can be attenuated or eliminated by pretreatment with IV lidocaine. Implications: Pain on injection of rocuronium in pediatric patients can be alleviated by pretreatment with IV lidocaine.