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

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

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

University orthopedic surgical center.

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

Patients randomly received 2 micrograms/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.

Prior injection of fentanyl (2 micrograms/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.

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