Effect of metoclopramide on mivacurium-induced neuromuscular block

In order to investigate the effect of metoclopramide on the duration of action of mivacurium, 45 patients were randomized into three groups. Group M10 (n = 15) and M20 (n = 15) received 10 and 20mg of metoclopramide i.v., respectively, and group S (n = 15) received saline 2min before induction of anesthesia with fentanyl, thiopental and mivacurium. Plasma cholinesterase activity (pCHE) was measured before induction of anesthesia and 2 min after injection of metoclopramide and saline. Neuromuscular block was monitored by a force transducer using train of four nerve stimulation. Anesthesia was maintained with isoflurane and N₂O. Time to recovery of a twitch height of 90% was significantly prolonged in group M10 and M20 (44±15 and 57±10min) as compared to group S, 32±9min, P<0.05). A slight but significant decrease in pCHE was observed in group M20. Because of the risk of prolonged duration of action of mivacurium, neuromuscular blockade should always be monitored whenever metoclopramide is given before injection of mivacurium.