Postoperative Myalgia Research Articles

Lidocaine pre-treatment for Succinylcholine induced postoperative myalgia and associated factors: Longitudinal study

IntroductionPostoperative myalgia in surgical patients is mainly caused by the routinely administered depolarizing muscle relaxant, Succinylcholine. There are many proposed strategies but no one were indicated as ideal preventive mechanisms for Succinylcholine induced post-operative myalgia. Even if data were sparse, Lidocaine pretreatment can reduce postoperative myalgia which requires further supportive evidences urging the initiation of this study. MethodsProspective longitudinal cohort study was conducted from March to May 2021 at Dessie Comprehensive Specialized Hospital on 208 adult surgical patients. Patients pretreated with Lidocaine preoperatively were grouped as exposed and others as unexposed. Patients meeting the inclusion criteria during the study period were selected sequentially from the daily operation schedule list. Postoperative myalgia level was measured using post-operative myalgia survey repeatedly. The result was analyzed by Cochran's Q test and generalized estimating equation (GEE). Adjusted odds ratio with 95 % confidence interval and p value < 0.05 was used to show the difference, direction and strength of association. ResultExposure specific incidence rate showed that 22 %, 22 % and 29.8 % of patients exposed to Lidocaine and 40.6 %, 42.7 % and 34 % not exposed to Lidocaine developed myalgia at 12, 24, and 48 h respectively. There is no significant difference in the incidence of myalgia over time between the repeated measurements in Lidocaine exposed patients (p = 0.513) but in non-exposed patients (p = 0.003). Also, there is no difference in the distribution of other predictors between Lidocaine exposed and non-exposed groups (p > 0.05). Exposure to Lidocaine reduces postoperative myalgia significantly [AOR = 0.33, 95 % CI = (0.17,0.66)]. Multimodal analgesia [AOR = 0.32, 95 % CI = (0.18,0.55)], non-steroidal anti-inflammatory drugs alone [AOR = 0.47, 95 % CI = (0.29,0.76)], postoperative immobility [AOR = 0.61, 95 % CI = (0.47,0.8)], and being male [AOR = 0.48, 95 % CI = (0.26,0.87)] were other determinants in reducing Succinylcholine induced postoperative myalgia. ConclusionLidocaine pretreatment can significantly reduce the occurrence of Succinylcholine induced postoperative myalgia. Additionally, usage of multimodal analgesia with non-steroidal anti-inflammatory drugs or even only non-steroidal anti-inflammatory drugs in the intraoperative and postoperative period can reduce Succinylcholine induced postoperative myalgia.

Comparison of Different Doses of Pregabalin to Prevent Succinylcholine-Initiated Fasciculations and Myalgia in Patients Under General Anesthesia: A Randomised Controlled Study.

Background Succinylcholine (SCh) is the most commonly used muscle relaxant during endotracheal intubation, and it is known to cause fasciculations and postoperative myalgia. Pregabalin is structurally similar to the neurotransmitter gamma-aminobutyric acid (GABA), which is known to reduce SCh-induced fasciculations and myalgia. Materials and methods This study was conducted on patients who underwent surgery under general anesthesia. A total of 201 patients of both genders were assigned to one of the following groups:Group PL (pregabalin low dose) received cap pregabalin 75 mg, Group PH (pregabalin high dose) received cap pregabalin 150 mg, and Group P (placebo) received saccharine pill 10 mg, administered two hours prior to surgery. Results Both the incidence and severity of fasciculations and myalgia were reduced in patients who received pregabalin compared to the placebo group (PH>PL>P). It was observed that as the severity of fasciculations increased, myalgia also increased. The time of the first analgesic dose was longer in the pregabalin group (PH>PL>P). The attenuation of pressor response and hemodynamic stability was greater in the pregabalin group (Group PH>PL>P). Sedation levels were insignificant among groups. The incidence of adverse effects was also insignificant. Conclusion Preoperative prophylactic administration of pregabalin orally in Group PL and PH reduced the incidence and severity of fasciculations and myalgia. Group PH was found to be more effective than PL. Pressor response attenuation was found to be more effective in Group PH.

Prevalence and associated factors of postoperative suxamethonium-induced myalgia in surgical patients at Debre Tabor Comprehensive Specialized Hospital Ethiopia: a cross-sectional study

Suxamethonium is considered by many to be the best drug for providing ideal intubating conditions, short surgical procedures, and rapid sequence induction. However, its usefulness is limited by the frequent occurrence of adverse effects like postoperative myalgia. Therefore this study aimed to assess the prevalence and associated factors of postoperative suxamethonium-induced myalgia. An institutional-based cross-sectional study was conducted on 210 patients who underwent surgery with general anesthesia. The data was collected by using structured and pretested questionnaires and analyzed using SPSS version 20.0. Logistic regression was conducted to identify significant predictors based on a P-value of less than 0.05 with a 95% confidence level. Among 210 patients the prevalence of suxamethonium-induced postoperative myalgia in the first 48 h was 88 (41.9%). Patients having previous anesthesia and surgical exposure (AOR 5.29, 95% CI 1.86–15.05), patients having a co-existing disease (AOR 2.69, 95% CI 1.08–6.67), patients that had not taken premedication (analgesia) (AOR 4.64, 95% CI 1.69–12.74), anesthesia maintenance using halothane (AOR 4.5 95% CI 1.7–11.4) and relaxation maintained with suxamethonium (AOR 3.1, 95% CI 1.2–8.1) were significantly associated with the prevalence of postoperative myalgia. The magnitude of suxamethonium-induced postoperative myalgia was high. So it is better to do with preventive techniques. As much as possible it is better to avoid using suxamethonium and necessary to use better to Premedicate with nonsteroidal anti-inflammatory drugs and non-depolarizing neuromuscular medications.

Intravenous Lidocaine Efficacy in Preventing Succinylcholine-Induced Postoperative Myalgia in Surgical Adult Patients at Tikur Anbessa Specialized Hospital

Intravenous Lidocaine Efficacy in Preventing Succinylcholine-Induced Postoperative Myalgia in Surgical Adult Patients at Tikur Anbessa Specialized Hospital

The Effects of Prophylactic Intravenous Lignocaine vs Vecuronium on Succinylcholine-Induced Fasciculation and Postoperative Myalgia in Patients Undergoing Elective Surgery at Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2022: Prospective Cohort Study.

The incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia have been shown to decrease when vecuronium bromide or preservative-free 2% plain lignocaine hydrochloride is administered before induction. The aim of this study is to examine the effectiveness of defasciculation dosages of vecuronium bromide and 2% preservative-free plain lignocaine hydrochloride in decreasing succinylcholine-induced fasciculation and postoperative myalgia in patients undergoing elective surgery. A total of 110 participants were included in a prospective observational cohort study that was located in an institution. Patients were randomly assigned to (Group L) and (Group V) based on the prophylactic measures they received from the responsible anesthetist utilizing preservative-free 2% plain lignocaine and defasciculation dose of vecuronium bromide, respectively. We recorded, socio-demographic variables, fasciculation, postoperative myalgia, total number of analgesics administered following surgery in 48hrs, and kind of procedure. The descriptive data were compiled using descriptive statistics. Categorical and continuous data were evaluated, respectively, using chi-square statistics and the independent sample t-test. To compare the prevalence of fasciculation and myalgia across the various groups, the Fischer exact test was performed. A 0.05 p-value was deemed statistically significant. This study found that the incidence of fasciculation in the groups receiving the defasciculation doses of vecuronium bromide and preservative-free 2% plain lignocaine hydrochloride was 14.6% and 20% (p-value 0.007), respectively. The rate of mild-to-moderate postoperative myalgia in the vecuronium bromide group was 23.7%, 30.9%, and 16.4% in the first, 24th, and 48th hours, respectively (p-value 0.001), as opposed to 0%, 37.3%, and 9.1%, respectively (p-value 0.008) in the group receiving preservative-free 2% plain lignocaine hydrochloride. Pretreatment with 2% plain lignocaine that is preservative-free is more efficient than vecuronium bromide at reducing the frequency and intensity of postoperative succinylcholine-induced myalgia, whereas defasciculation dose of vecuronium was more effective prevention of succinylcholine-induced fasciculation.

Comparison of the efficacy of atracurium pretreatment versus magnesium sulphate for prevention of suxamethonium-induced fasciculation and post-operative myalgia

Background: Suxamethonium remains the best option for rapid sequence induction, it is the only depolarizing muscle relaxant in clinical use. However, fasciculation and myalgia are frequent adverse effects of the drug. Myalgia can last for several days with associated discomfort. Non-depolarizing muscle relaxant and magnesium sulphate have been tried as pretreatments to attenuate the fasciculation and myalgia with varying results.Methods: A double blind, randomized study of 100 adult surgical patients of ASA I or II Class were recruited to receive either intravenous atracurium (0.05mg/kg) (Group A) or intravenous magnesium sulphate (30mg/kg)(Group B). The occurrence, severity and duration of fasciculation as well as the occurrence and severity of post-operative myalgia were also recorded.Results: Muscle fasciculation occurred in 39 (78%) patients in Group A and 27(54%) patients in Group B (p= 0.001). The severity of fasciculation was mild to moderate in Group B while Group A in addition also recorded some cases of severe episodes of fasciculation. Mean duration of fasciculation in Group A waslonger (28.48 ± 1.07sec) than in group B (19.44± 1.93seconds) (p= 0.001). Post-operative myalgia was not experienced at 6hrs and 48hrs, while 2 patients (1 in each Group) had it at 12hrs. At 24hrs, postoperative myalgia was present in 13(26%) patients in group A and 5(10%) patients in group B, (p=0.043). The severity of post-operative myalgia recorded both at 12hrs and 24hrs was mild.Conclusion: Magnesium sulphate demonstrated better efficacy at reducing fasciculation and postoperative myalgia than atracurium

MP74-20 THE USE OF A LOW-DOSE NON-DEPOLARIZING NEUROMUSCULAR BLOCKER DOES NOT AFFECT OPENING MOTOR THRESHOLDS FOR SACRAL NEUROMODULATION

You have accessJournal of UrologyCME1 Apr 2023MP74-20 THE USE OF A LOW-DOSE NON-DEPOLARIZING NEUROMUSCULAR BLOCKER DOES NOT AFFECT OPENING MOTOR THRESHOLDS FOR SACRAL NEUROMODULATION Courtney Nguyen, Nicholas Major, Mason Holtel, and Colin Goudelocke Courtney NguyenCourtney Nguyen More articles by this author , Nicholas MajorNicholas Major More articles by this author , Mason HoltelMason Holtel More articles by this author , and Colin GoudelockeColin Goudelocke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Succinylcholine is a popular muscle relaxant for ambulatory anesthesia and short surgical procedures. With a half-life of less than one minute, it is an excellent anesthetic agent for sacral neuromodulation (SNM) due to its quickly-dissipating properties. This allows for optimal lead placement using anal bellows and toe twitch responses that would otherwise be affected by longer-acting agents. A prominent side effect of succinylcholine is postoperative myalgias, characterized as muscle stiffness and aching that can last several days following the procedure. In very low doses, Rocuronium, a non-depolarizing muscle relaxant, is often given alongside succinylcholine to prevent muscle fasciculation and postoperative myalgia. These defasciculating doses are thought to minimally affect the neuromuscular synapse and are presumed to have minimal effects on motor response during testing. METHODS: A single-institution, IRB-approved, retrospective review was performed on all patients who underwent staged testing of Sacral Neuromodulation at Ochsner Health Center from July 2019 to July 2021 (n=121). Data collected included whether a longer-acting neuromuscular blocker (rocuronium) was used, the dose if used, and motor thresholds for bellow and toe responses for all electrodes. All leads were placed by a single surgeon (CG). Statistical analysis was performed using ANOVA and Student’s T-Test and corrected with Bonferroni. RESULTS: A defasciculating dose of rocuronium (≤10 mg) was used in 82/121. Thirty-four patients received no neuromuscular blockade. The mean opening threshold for bellow response was 0.919±0.0056 mA for patients not pre-treated with rocuronium and 0.999±0.072 mA for those that received a defasciculating dose (p=0.32). The mean opening threshold for toe response between the non-rocuronium group versus the rocuronium pretreated was 0.949±0.0036 mA and 0.958±0.00067 mA, respectively (p=0.82). CONCLUSIONS: There was no statistically significant difference between opening thresholds for bellows or toe when comparing rocuronium and non-rocuronium groups. This study suggests that rocuronium can safely be administered to reduce postoperative myalgia without altering SNM lead placement. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1078 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Courtney Nguyen More articles by this author Nicholas Major More articles by this author Mason Holtel More articles by this author Colin Goudelocke More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of Pregabalin on Succinylcholine Induced Fasciculation, Myalgia and Hyperkalemia in Spine Surgery

A randomized control trial was done between January and December of 2018, in the Department of Anaesthesia, Analgesia, Palliative &amp; Intensive Care Medicine of Dhaka Medical College Hospital, Bangladesh, to evaluate the preventive effect of pregabalin on succinylcholine induced adverse effects, i.e., fasciculation, myalgia and hyperkaliemia in spine surgery. Sixty patients of elective spine surgery under general anaesthesia were selected and divided into two groups. Pregabalin 150 mg was given to one group and matching placebo was given to another group orally with sips of water one hour before surgery. Succinylcholine 1.5 mg/kg was given after induction agent. Muscle fasciculation was observed just after succinylcholine administration. Serum potassium was measured 5 minutes before induction and 5 minutes after succinylcholine administration. After completion of surgery reversal was given. Time of first analgesic demand was recorded. Injection Morphine 0.15 mg/kg intramuscular was given when patient complained about pain. Myalgia (muscle pain not associated with surgery) was observed 24 hours after anaesthesia and total morphine consumption was recorded. Use of pregabalin 150 mg one hour before surgery reduced the severity of fasciculation and the incidence and severity of postoperative myalgia. It also reduced the rise of serum potassium concentration after succinylcholine administration though the rise was within normal limit. Pregabalin also reduced the total opioid consumption after surgery.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 73-80

Postoperative weakness and anesthetic-associated rhabdomyolysis in a pediatric patient: a case report and review of the literature

BackgroundAnesthesia-associated rhabdomyolysis is a rare complication of surgery that causes postoperative myalgia, weakness, and potential renal failure if not managed promptly. Predisposing conditions that may lead to this complication include muscular dystrophies and myopathies.Case presentationThis rare case describes a pediatric non-Indigenous Australian patient developing this complication, with no known predisposing risk factors, and no clear etiology. A 9-year-old child with a background of asthma underwent an elective removal of keloid scar on her chest wall. The procedure was brief and uncomplicated, with an uneventful induction of anesthesia. During the emergence period, she developed acutely raised airway pressures with bronchospasm and laryngospasm requiring the use of salbutamol and suxamethonium with good effect. In the initial postoperative period, the patient complained of generalized myalgia and muscle weakness and was unable to mobilize independently. There was transient recovery to normal function; however, a recurrence of symptoms the following day with associated myalgias warranted admission to hospital. She was found to have rhabdomyolysis that was managed conservatively with a full recovery of several weeks. She was thoroughly investigated for any underlying cause, including genetic testing for malignant hyperthermia susceptibility (she had a variant of unknown significance but was negative for the known genetic abnormalities that cause malignant hyperthermia).ConclusionThis case report demonstrates the importance of considering anesthesia-associated rhabdomyolysis as a differential for acute postoperative weakness, and outlines an investigative approach. To the best of our knowledge, it is the first case described in the pediatric literature to report biphasic progression of symptoms.

Post-Suxamethonium Muscle Pains after Vitamin C Pretreatment

Background: Succinylcholine has been extensively used for endotracheal intubation because of its ultrashort duration of action, quick onset with complete and predictable paralysis. However, the occurrence of some side effects like post injection fasciculations, postoperative myalgia, and increase in serum potassium levels limits its use in some situations like burns, myopathies, and myoglobinuria. For attenuation of these effects, many drugs have been studied but with limited success. Aims and objectives: To evaluate the role of vitamin C on attenuation of post-suxamethonium myalgia and increase in serum potassium levels. Materials and methods: Seventy-five females of American Society of Anaesthesiologists grade I and II and aged 20 to 50 years undergoing general anesthesia for various short surgical procedures were randomly allocated into three groups. Induction of anesthesia was performed with injection thiopentone 5 mg/kg body weight and suxamethonium 50 mg in all three groups. In group I, no drug was administered before induction of anesthesia. In group II, 500 mg tablet of vitamin C was administered twice orally a day before and on the day of surgery half an hour before induction of anesthesia. In group III, vitamin C 500 mg was administered intravenously in 50 ml saline half an hour before induction of anesthesia. The absence or presence of muscle pains and fasciculations were noted and if present, then their severity was also estimated. Serum potassium levels were measured in the venous samples collected just before induction and at 5-minute interval after the administration of suxamethonium. Patients were observed for myalgia on postoperative days 1, 2, and 3. Results: The patients receiving vitamin C had a little reduction in the incidents but marked reduction in severity of muscle pains and fasciculation. Furthermore, the administration of vitamin C markedly delayed the onset of muscle pains. There was no effect of vitamin C pretreatment on serum potassium levels. Conclusion: Pretreatment with vitamin C 500 mg may be useful in reduction of severity of post- suxamethonium myalgia.

A Comparison of Prophylactic Use of Intravenous Lidocaine versus Vecuronium in Preventing Suxamethonium - Induced Fasciculation and Postoperative Myalgia among Surgical Patients at Hawassa University Specialized Hospital, Ethiopia: Prospective Cohort Study

Succinylcholine is the preferred muscle relaxant used for rapid sequence induction with a minor adverse effect that leads to an unpleasant experience for the patients. Administration of IV lidocaine or Vecuronium before succinylcholine has been shown to decrease the incidence and severity of succinylcholine-induced fasciculation and postoperative myalgia.

Effect of pre-treatment with rocuronium and vecuronium on post succinylcholine fasciculations, serum potassium, and postoperative myalgia: A prospective, randomized, double-blind study

Background: Succinylcholine with quick onset, ultra short duration of action, and complete predictable paralysis has been the best drug for endotracheal intubation but the occurrence of side effects such as muscle fasciculations, postoperative myalgia, rise in serum potassium levels and myoglobinuria limits its use in the full stomach, burns, massive trauma, metabolic acidosis, and few myopathies. For attenuation of these effects, many drugs have been studied but pre-treatment with non-depolarizing muscle relaxant found to be successful. Aims and Objectives: This study was designed to assess the effect of Rocuronium and Vecuronium pre-treatment on post-succinylcholine fasciculations, rise in serum potassium levels, and postoperative myalgia. Materials and Methods: 100 patients between the age of 20–50 years of either sex (American Society of Anaesthesiologists grade I and II) undergoing general anesthesia for various surgical procedures were randomly allocated into two groups according to pre-treatment with Rocuronium (Group R) and Vecuronium (Group V) before Succinylcholine administration. After Succinylcholine administration severity of fasciculations, rise in serum potassium after 5 min and myalgia on postoperative days 1, 2, and 3 were recorded. Results: About 74% patients had no fasciculation in Group R as compared to 36% in group V. Statistically insignificant (P&gt;0.05) rise in serum potassium level was observed in both groups. Higher number of patients had mild-to-moderate degree of myalgia with Vecuronium on postoperative days 2 and 3. Conclusion: Pre-treatment with Rocuronium before Succinylcholine provided better attenuation of post-succinylcholine muscle fasciculations, postoperative myalgia with statistically insignificant rise in serum potassium levels.

Evaluation of the effectiveness of arnica montana 6ch in the control of postoperative myalgia by isometric effort in dentistry

Introduction: Arnica montana 6CH is a medicine indicated for inflammatory and painful conditions, especially in muscle structures. The RDC / TMD Axis II questionnaire is a validated tool for the diagnosis of Temporomandibular Muscle Dysfunction. Objective: This multicenter, randomized and controlled study, approved by Human or Animal Research Ethics Committee UniFOA - CAAE: 48680015.3.0000.5237 aimed to verify the clinical performance of Arnica montana 6CH in contractures and muscle pain triggered by isometric stress. Materials and Methods: 70 patients underwent prolonged dental treatment sessions, and they were selected after clinical examination and positive responses to the RDC / TMD questionnaire to confirm signs and symptoms of Temporomandibular Muscle Dysfunction at the first consultation. Randomly, Arnica montana 6CH was prescribed for 35 patients called group I, and placebo for 35 patients called group II, at a dose of 5 globules, 03 times a day, for 1 week. In the second endodontic consultation, after 15 days, a new clinical examination was performed at the beginning and end of the prolonged dental consultation with crossing of data from the RDC questionnaire, to monitor the prevalence of TMD muscle signs and symptoms. The data were tabulated and analyzed. Statistical analysis: The test t de Student was used for paired samples, significant at the level ≤ 0.05%. Results: Anamnetic data from the RDC questionnaire, 86% of the individuals in the GI had lower pain and muscle contracture rates in the second consultation, compared with 22% in the GII. Conclusion: The drug Arnica montana 6CH proved to be effective in preventing muscle changes and clinical symptoms resulting from isometric efforts with a statistically significant difference (p ≤ 0.05).

Comparison of the Effect of Pretreatment with Cisatracurium and Rocuronium on Succinylcholine Induced Fasciculation for Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospitalbased, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and Group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection were observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Post Anesthesia Care Unit (PACU) on postoperative day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in Group 2 (mean 0.2187±0.4200) than Group 1 (mean 1.125±0.833, p&lt;0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than Group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia.

Effect of Non-depolarizing Muscle Relaxants Rocuronium Versus Vecuronium in the Assessment of Post-Succinylcholine Complications in Surgeries Under General Anesthesia: A Randomized Double-Blind Study at a Tertiary Care Hospital.

Background and objectiveSeveral drugs have been used to prevent or attenuate succinylcholine-induced muscle fasciculations and myalgia. We designed the present study to evaluate the efficacy of rocuronium (ROC) and vecuronium (VEC) in preventing succinylcholine-induced fasciculations and postoperative myalgia (POM) in patients undergoing surgery under general anesthesia.Materials and methodsAfter obtaining written informed consent, 125 patients were randomly selected to receive either ROC 0.06 mg/kg or VEC 0.01 mg/kg, with both diluted up to 2 ml, 90 seconds before the administration of propofol followed by succinylcholine. A standardized balanced anesthetic technique was used for all patients. The intensity of fasciculations and intubating conditions were assessed using a 4-point rating scale. All patients were evaluated up to the third postoperative day for the presence of POM, the severity of which was graded on a 4-point scale.ResultsThe incidence of post-succinylcholine fasciculations during induction was nil in 74.58% of patients in the ROC group and 51.52% in the VEC group. Mild fasciculation was seen in 22.03% in the ROC group and 33.33% in the VEC group. Moderate fasciculation was seen in 3.39% and 15.15% in ROC and VEC groups respectively. When comparing both the groups, a significant decrease (p=0.015) in intraoperative fasciculation was observed in the ROC group than in the VEC group. Both drugs provided good intubating conditions without any statistical significance and with an overall intubating score of 8-9 in both groups as per Lund. On day one, 91.53% (n=54) of the ROC group and 65.15% (n=43) of the VEC group patients did not have any myalgia symptoms. Mild myalgia was observed in 8.47% (n=5) in the ROC group and 31.82% (n=21) in the VEC group, and only 1.8% had moderate myalgia in the VEC group. The results of the study showed that POM was significantly decreased in the ROC group than in the VEC group on day one (p=0.001). The incidence of POM on day two was significantly low in both groups. There was no statistical significance between the two groups based on Fisher's exact test (p=1.000). None of the patients had myalgia on day three.ConclusionOur results showed that the incidence and severity of fasciculations and POM were significantly decreased by pretreatment with ROC in contrast to that with VEC. Hence, ROC is a better option than VEC to combat succinylcholine-related complications like fasciculation and myalgia.

The Antioxidant Effect of Selenium on Succinylcholine-related Myalgia After Adult Sinuscopies: Randomized Controlled Double-Blind Trial

Succinylcholine has a fast onset, short duration of action, and is considered the choice for rapid sequence intubation. However, it produces muscle stiffness and postoperative myalgia (POM) as adverse effects. We hypothesized that the antioxidant selenium might affect POM incidence and severity. The study aimed to investigate the antioxidant effect of selenium (against free radicals' release) in minimizing the frequency of succinylcholine-related POM, measured by the 4-point myalgia score. The severity of fasciculations and the postoperative analgesic profile were recorded. The correlation between fasciculations and POM was also observed. A prospective randomized controlled double-blind clinical study. Assiut University Hospitals. The current study included 80 adult patients scheduled for sinuscopies and randomly assigned into 2 equal groups. Two hours before the induction of general anesthesia, patients in the control group received oral placebo tablets, while patients in the selenium group received oral selenium 200 µg. The primary outcome of this trial was the POM score at 24 hours. Secondary outcomes included the intensity of fasciculations, Numeric Rating Scale (NRS), rescue analgesic consumption, and adverse effects of the studied drugs. Myalgia scores were significantly decreased after selenium administration throughout the follow-up period (P = 0.023). No significant difference was reported regarding the incidence or degree of fasciculations (P = 0.511). A mild correlation was noticed between fasciculations and POM with r = 0.176 and P < 0.061. The NRS values were significant between groups at 6 hours after the procedure. There were significant differences (P < 0.05) regarding postoperative supplement analgesia, time to the first rescue analgesia, and the mean total number of analgesic claims. Significant differences were recorded for potassium levels only 30 minutes and creatine kinase levels at 6 and 24 hours postoperatively. This study was applied on a single surgical category and other types of surgical procedures may have an effect on outcomes. Additional larger sample size studies and various doses of selenium may help to validate our results. Selenium is quite a significant element of the enzymatic antioxidant process through glutathione peroxidase. We did not measure the glutathione peroxidase level in blood. Oral selenium effectively reduced the succinylcholine-induced postoperative myalgia. It prolonged the time to first required analgesia and decreased the analgesic consumption throughout the whole study period without affecting the hemodynamics or any serious adverse effects.

A small dose of succinylcholine versus de-fasciculating dose of pancuronium for the prevention of succinylcholine-induced side effects in surgical patients: A prospective cohort study

BackgroundThe onset of paralysis by succinylcholine is usually signaled by visible motor unit contractions called fasciculation. Even though it is a short-acting muscle relaxant of choice that facilitates endotracheal intubation, it has some side effects. The most common side effects are fasciculation and post-operative myalgias which are unpleasant experiences for the patient lasting 24–48 h after surgery. The current study aimed to compare the effect of a mini-dose of succinylcholine versus a de-fasciculating dose of pancuronium for the prevention of succinylcholine-induced side effects in surgical patients. MethodsThis is a prospective cohort study that recruited 96 patients who underwent elective surgery. Patients were grouped into three study arms: 1. 0.01mg/kg pancuronium, 2. 0.2mg/kg succinylcholine, and 3. with no pretreatment. Data were analyzed using one-way analysis of variance (ANOVA) with post hoc analysis for multiple tests and non-normally distributed data were analyzed using the Kuruska-Wallih H rank test. P-values < 0.05 were considered as statistically significant. ResultsThe total incidence of succinylcholine-induced fasciculation was 17 (53.1%), 8(25%), and 30 (93.8%) in pancuronium, mini-dose of succinylcholine pretreatment and unexposed groups, respectively (p<0.001). The severity of fasciculation was reduced more in mini-dose succinylcholine than in the other two groups. The total incidence of myalgia was 6(18.8%), 3(9.4%), and 9(28.1%) in pancuronium, mini-dose of succinylcholine, and unexposed groups, respectively (p=0.158). There was no difference in the severity of myalgia between groups (p=0.161). There was no statistically significant difference in the incidence and severity of succinylcholine-induced postoperative myalgia among the three groups. ConclusionPretreatment with a mini-dose of succinylcholine might reduce the incidence and severity of succinylcholine-induced fasciculation in patients undergoing elective surgery. In this study, pre-treatment with a mini-dose of succinylcholine or pancuronium did not demonstrate an effect on the incidence or severity of succinylcholine-induced myalgia.

Impact of duloxetine on succinylcholine-induced postoperative myalgia after direct microlaryngoscopic surgeries: Randomized controlled double-blind study.

Succinylcholine is a preferred muscle relaxant for rapid sequence intubation. Postoperative myalgia (POM) is one of its commonest adverse effects with unknown pathogenesis. Various modalities were examined to reduce POM. We hypothesized that duloxetine may reduce the incidence and severity of fasciculation or succinylcholine-induced POM in outpatient surgeries. This randomized double-blinded trial involved controlled 70 adult participants scheduled for elective direct microlaryngoscopic surgeries. Before induction of general anesthesia by 2h, 35 patients received duloxetine 30mg orally (group D) and 35 patients received similar oral starch placebo capsules (group C). Fasciculations, POM, sedation score, time to first rescue analgesia, total analgesic consumption 24h after surgery, patients' satisfaction, and adverse effects were recorded. Incidence of fasciculation was 77.1% and 94.3% in groups D and C (p value = 0.04), whereas its severity was not significant between groups (p value = 0.09). Incidence and severity of POM were significantly lower in group D (p values = 0.004 and 0.021). Positive correlation was recorded between fasciculations and POM scores (r=0.732 and p<0.001). Time required for first analgesia was prolonged in group D (p value<0.001) with less total analgesic consumption (p value=0.039). The potassium and creatine kinase levels showed significant differences between both groups after 30min and 24h, respectively (p value<0.05). Sedation scores and patients' satisfaction were better in duloxetine group (p value<0.05) with no severe complications. Preoperative oral duloxetine 30mg administration decreased incidence and severity of succinylcholine-related muscle POM and fasciculations. It was also effective in reducing postoperative rescue analgesic requirement with better patients' satisfaction and no serious adverse effects.

Incidence And Severity Of Suxamethonium Induced Fasciculation And Post-Operative Myalgia, And Their Association With Different Iv Induction Agents Among Adult Patients Underwent Elective Surgery At Jimma Medical Center, A Prospective Cohort Study

Incidence And Severity Of Suxamethonium Induced Fasciculation And Post-Operative Myalgia, And Their Association With Different Iv Induction Agents Among Adult Patients Underwent Elective Surgery At Jimma Medical Center, A Prospective Cohort Study

Effect of oral low dose pregabalin on succinylcholine induced fasciculations and myalgia -A prospective randomized double blind placebo-controlled study

Introduction: Among the depolarizing muscle relaxants, Succinylcholine is the widely used depolarizing agent until today in anaesthesia practice. Side effects like hyperkalemia, fasciculations, myalgia, increased intracranial pressure and intraocular pressure are common with the use of this drug. Pretreatment with various drugs have been proven to lessen these side effects. In our study, low dose of oral pregabalin was used as a premedication to assess its effects on the incidence and severity of fasciculations and postoperative myalgia caused by Succinylcholine administration. Materials and Methods: 60 patients of either gender undergoing elective ENT surgeries under general anaesthesia were randomly allocated to two groups of 30 each. Patients in Group PG (pregabalin group) received 75 mg of pregabalin orally 1 h prior to surgery and patients in Group CG (control group) received matching placebo. Fasciculations and myalgia grading was done by a blinded observer. Haemodynamic variables were measured at regular intervals. Results: Both groups were comparable in regard to Demographic data (p > 0.05). We didn’t find any significant difference in the fasciculations incidence (p=0.702) and myalgia incidence (p=0.081) between the two groups. But the severity of fasciculations is statistically significant between the groups (< 0>P < 0> Conclusion: Low dose oral pregabalin- 75 mg decreases the severity of succinylcholine-induced fasciculations and myalgia. There is not much effect on the incidence of fasciculations and myalgia in patients undergoing elective ENT surgeries. Keywords: Succinylcholine, Low dose Pregabalin, Fasciculations, Myalgia.