Neutralized rocuronium (pH 7.4) before administration prevents injection pain in awake patients: a randomized prospective trial

Abstract Study Objective To determine (1) the amount of 8.4% sodium bicarbonate (NaHCO3 ) to adjust the pH of rocuronium to 7.4 (neutralization), (2) to show whether neutralizing the pH of rocuronium can prevent pain, and (3) to confirm that rocuronium mixed with NaHCO3 does not change the physical property and efficacy of rocuronium. Design Prospective studies. Setting University medical center. Patients 180 ASA physical status I and II women patients undergoing elective gynecologic surgery. Interventions and Measurements 60 patients were randomly allocated to group 1 (rocuronium only), group 2 (rocuronium 50 mg mixed with 0.9% NaCl 3 mL), and group 3 (rocuronium 50 mg mixed with 8.4% NaHCO3 3 mL). All patients received mixtures equal to 0.04 mg/kg of rocuronium and were asked to evaluate their pain with visual analog scale (VAS) and pain scores. In other settings, the onset time and duration of action of each group of rocuronium were measured. The dose of rocuronium required to produce a 50% twitch depression (ED50 ) was calculated. Main Results The amount of 8.4% NaHCO3 needed to neutralize 50 mg of rocuronium was 3.1 ± 0.3 mL. VAS scores were lower in group 3 than in groups 1 or 2 ( P < 0.05). There were no differences in onset time, duration of action, or ED50 values among the groups. Conclusions Rocuronium neutralized with NaHCO3 prevents intravenous injection pain. The physical and pharmacologic properties of rocuronium mixed with NaHCO3 immediately before administration are not altered.