Schreiber JU, Lysakowski C, Fuchs-Buder T, Tramer MR. Prevention of succinylcholine-induced fasciculation and myalgia: a metaanalysis of randomized trials

Department of Anesthesiology and Critical Care Medicine, University Hospital of the Saarland, Homburg, Germany.
Anesthesiology (Impact Factor: 5.88). 10/2005; 103(4):877-84. DOI: 10.1097/00000542-200510000-00027
Source: PubMed

ABSTRACT Fifty-two randomized trials (5,318 patients) were included in this meta-analysis. In controls, the incidence of fasciculation was 95%, and the incidence of myalgia at 24 h was 50%. Nondepolarizing muscle relaxants, lidocaine, or magnesium prevented fasciculation (number needed to treat, 1.2-2.5). Best prevention of myalgia was with nonsteroidal antiinflammatory drugs (number needed to treat, 2.5) and with rocuronium or lidocaine (number needed to treat, 3). There was a dose-dependent risk of blurred vision, diplopia, voice disorders, and difficulty in breathing and swallowing (number needed to harm, < 3.5) with muscle relaxants. There was evidence of less myalgia with 1.5 mg/kg succinylcholine (compared with 1 mg/kg). Opioids had no impact. Succinylcholine-induced fasciculation may best be prevented with muscle relaxants, lidocaine, or magnesium. Myalgia may best be prevented with muscle relaxants, lidocaine, or nonsteroidal antiinflammatory drugs. The risk of potentially serious adverse events with muscle relaxants is not negligible. Data that allow for a risk-benefit assessment are lacking for other drugs.

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Available from: Jan-Uwe Schreiber, Sep 28, 2015
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    • "Succinylcholine-induced fasciculation and postoperative myalgia are a well-recognized side effect with the reported incidence of 95% and 50%, respectively [3]. Myalgia after the use of succinylcholine is most frequent on the first postoperative day [11]. "
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    ABSTRACT: Background Succinylcholine commonly produces frequent adverse effects, including muscle fasciculation and myalgia. The current study identified the optimal dose of rocuronium to prevent succinylcholine-induced fasciculation and myalgia and evaluated the influence of rocuronium on the speed of onset produced by succinylcholine. Methods This randomized, double-blinded study was conducted in 100 patients randomly allocated into five groups of 20 patients each. Patients were randomized to receive 0.02, 0.03, 0.04, 0.05 and 0.06 mg/kg rocuronium as a precurarizing dose. Neuromuscular monitoring after each precurarizing dose was recorded from the adductor pollicis muscle using acceleromyography with train-of-four stimulation of the ulnar nerve. All patients received succinylcholine 1.5 mg/kg at 2 minutes after the precurarization, and were assessed the incidence and severity of fasciculations, while myalgia was assessed at 24 hours after surgery. Results The incidence and severity of visible muscle fasciculation was significantly less with increasing the amount of precurarizing dose of rocuronium (P < 0.001). Those of myalgia tend to decrease according to increasing the amount of precurarizing dose of rocuronium, but there was no significance (P = 0.072). The onset time of succinylcholine was significantly longer with increasing the amount of precurarizing dose of rocuronium (P < 0.001). Conclusions Precurarization with 0.04 mg/kg rocuronium was the optimal dose considering the reduction in the incidence and severity of fasciculation and myalgia with acceptable onset time, and the safe and effective precurarization.
    Korean journal of anesthesiology 06/2014; 66(6):451-6. DOI:10.4097/kjae.2014.66.6.451
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    • "A meta-analysis found that the average incidence of myalgia at 24 h was 65.4% with propofol and 49.2% with thoipentone.[28] The result of this meta-analysis however do not tally with the findings of McClymont,[8] whose study was surprisingly not included in the meta-analysis. "
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    ABSTRACT: Magnesium sulfate and propofol have been found to be effective against succinylcholine-induced fasciculations and myalgia, respectively, in separate studies. A prospective randomized double blind controlled study was designed to assess the effect of a combination of magnesium sulfate with propofol for induction of anesthesia on succinylcholine-induced fasciculations and myalgia. Randomly selected 60 adult patients scheduled for elective surgery under general anesthesia were allocated to one of the two equal groups by draw of lots. The patients of MG Group were pretreated with magnesium sulfate 40 mg/kg body weight in 10 ml volume, while patients of NS group were given isotonic saline 0.9% in the same volume (10 ml) intravenously slowly over a period of 10 min. Anesthesia was induced with fentanyl 1.5 mcg/kg and propofol 2 mg/kg, followed by administration of succinylcholine 2 mg/kg intravenously. Muscle fasciculations were observed and graded as nil, mild, moderate, or severe. Postoperative myalgia was assessed after 24 h of surgery and graded as nil, mild, moderate, or severe. Observations were made in double blind manner. Demographic data of both groups were comparable (P > 0.05). Muscle fasciculations occurred in 50% patients of MG group versus in 100% patients of NS group with a significant difference (P < 0.001). After 24 h of surgery, no patient of MG group and 30% patients of NS group had myalgia with a significant difference (P < 0.002). Magnesium sulfate 40 mg/kg intravenously may be used with propofol for induction of anesthesia to control succinylcholine-induced fasciculations and myalgia.
    Journal of Anaesthesiology Clinical Pharmacology 03/2012; 28(1):81-5. DOI:10.4103/0970-9185.92451
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    • "Generally this pretreatment is reported to reduce the incidence of postoperative myalgia caused by the administration of succinylcholine by 30 percent (Pace, 1990). A meta analysis concluded that pretreatment with nondepolarizing muscle relaxant, benzodiazepine or local anaesthetic decreased their incidence by about 30 percent (Schreiber et al., 2005). Thompson-Bell in 1996 found 0.03 mg/kg pretreatment dose of rocuronium effective in decreasing incidence and severity of postoperative myalgia. "
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    ABSTRACT: Succinylcholine remains the drug of choice in conditions where rapid paralysis and airway control are priorities. However it is associated with muscular side effects that have an overall incidence ranging from five to 83 percent. The administration of small doses of nondepolarizing muscle relaxants before the administration of succinylcholine has been shown to decrease the incidence and severity ofmuscular side effects experienced by the patients. This study was aimed at evaluating the efficacy of technique in reducing the muscular side effects of succinylcholine. Sixty healthy adults were enrolled in the study who were scheduled for minor muscle cutting surgeries under general anaesthesia. They were assigned at random to two groups of thirty patients each. They randomly received succinylcholine for intubation and a precurarization dose of rocuronium followed by succinylcholine for intubation. Intraoperative fasciculations and postoperative myalgia were graded and scored. There was a significantly increased incidence of fasciculations and myalgia in the succinylcholine group. In the precurarization group the incidence and severity of fasciculations and myalgia was significantly less as compared to the group which received succinylcholine alone. Wefound significant correlation between fasciculations and myalgia in the succinylcholine group. Present study concluded that precurarization with rocuronium was effective in reducing the succinylcholine-induced fasciculations and myalgia.
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