Spontaneous movements associated with rocuronium injection: The effects of prior administration of fentanyl

Study Objective: To determine if prior injection of fentanyl decreases the incidence of spontaneous movements during rocuronium administration.

Design: Prospective, randomized, double-blind, placebo-controlled study.

Setting: University orthopedic surgical center.

Patients: 122 ASA physical status I and II patients scheduled for elective orthopedic surgery.

Interventions: Patients randomly received 2 ug/kg of fentanyl or the equivalent volume of NaCl 0.9% 45 seconds prior to induction of anesthesia. Induction was performed with propofol 2.5 mg/kg followed by rocuronium 0.8 mg/kg 60 seconds later. Spontaneous movements were scored as follows: a) limited to the hand, b) limited to the elbow, and c) involving the whole arm, including the shoulder.

Measurements and Main Results: Prior injection of fentanyl (2 ug/kg) significantly decreased the incidence of spontaneous movements limited to the hand: 5% versus 20% (p < 0.05); limited to the elbow: 1 % versus 25% (p < 0.05); and involving the whole arm: none versus 12% (p < 0.05). No erythema or any change in the skin surrounding the point of injection of the involved arm was observed. Twenty-four hours later, no vein induration was present and no patient complained of any residual pain.

Conclusion: Prior injection of fentanyl significantly decreases the incidence of spontaneous movements associated with rocuronium administration.