Post suxamethonium pains and vitamin C

The Effect of Pregabalin on the Prevention of Succinylcholine-Induced Fasciculation and Myalgia

PURPOSE

This study evaluates the effect of pregabalin on fasciculation and myalgia after using succinylcholine.

DESIGN

This randomized double-blind prospective study was conducted among 100 patients aged 20 to 60 years old.

METHODS

Pregabalin (300 mg) and placebo (in capsule form) were placed in similar containers. The results were analyzed by SPSS 23 software, and statistical analysis consisted of χ² test and t test, and a P value less than .05 was considered significant.

FINDINGS

The mean pain score in the group receiving pregabalin was lower than the placebo group. According to the χ² test, there was a significant difference between the two groups in the frequency of fasciculation (P = .003). Mean fasciculation severity in the pregabalin group was lower than placebo group. According to t test, there was a significant difference in the mean fasciculation severity between the two groups (P = .002).

CONCLUSIONS

This study showed that 300 mg of pregabalin was effective in reducing postoperative fasciculation and myalgia in patients treated with succinylcholine.

Succinylcholine-associated postoperative myalgia

The subject of postoperative myalgia associated with the use of succinylcholine is reviewed. We discuss the mechanisms of succinylcholine-induced myalgia and the techniques available to prevent and treat the myalgia. In situations where patients are at risk of developing myalgia and succinylcholine is the neuromuscular blocker of choice, the use of a combination of techniques may prove to be a useful strategy.

Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens

The incidence of muscle pains and changes in serum concentrations of potassium, calcium and creatine kinase following suxamethonium were investigated after no pretreatment or pretreatment with intravenous tubocurarine 0.05 mg.kg-1, intravenous chlorpromazine 0.1 mg.kg-1, alphatocopherol (vitamin E) 600 mg in three divided doses orally, aspirin 600 mg orally or intravenous calcium chloride 5 mg.kg-1 in groups of 20 patients each. The incidence of myalgia was reduced significantly by tubocurarine, chlorpromazine and alphatocopherol. However, the increase in creatine kinase was attenuated only in the groups of patients who received tubocurarine and chlorpromazine. The changes in serum potassium and calcium concentrations were within acceptable limits. The intubating conditions were not as good in the patients who received tubocurarine as in the other groups. Effectiveness of chlorpromazine in preventing both the myalgia and the biochemical changes suggests the involvement of phospholipases in the pathogenesis of suxamethonium-induced muscle damage.

The search for an optimal interval between pretreatment dose of d-tubocurarine and succinylcholine

A study was conducted to determine the optimal interval between the administration of d-tubocurarine (dTc) and succinylcholine (SCh) with regard to onset and duration of neuromuscular block and presence of fasciculations and postoperative myalgias. Forty female patients received dTc 3 mg X 70 kg-1 prior to SCh 1.5 mg X kg-1. The interval between drugs was 0, 1, 3, 5, or 7 minutes. Transduced thumb adduction recorded block onset and recovery. Fasciculations were visually detected. Myalgias were assessed on postoperative interview. Pretreatment interval did not affect the onset or recovery of neuromuscular block. Postoperative myalgias were also independent of pretreatment timing. Fasciculations were blocked with 3, 5, or 7 minute intervals, but not with 0 or 1 minute intervals. Therefore, three minutes appear to be the optimal time interval between administration of dTc and SCh since shorter intervals do not inhibit fasciculations and longer intervals do not afford any additional advantages.

Lignocaine pretreatment for suxamethonium. A clinicobiochemical study

Lignocaine pretreatment (2 mg/kg) significantly restricted the increase in serum potassium and decrease in serum calcium caused by suxamethonium. Suxamethonium muscle pains occurred in only 8% of patients who received lignocaine just before induction of anaesthesia. The incidence of muscle pains was 45% in those patients who were not given lignocaine.

Vitamin C and post-suxamethonium pains

A double-blind trial of the effects of vitamin C on the frequency, severity and duration of post-suxamethonium pains was performed. Fifty-three patients undergone bronchoscopy received either a placebo or 10 g of vitamin C. No beneficial effect was demonstrated. In 18 patients no relationship was found between pre-anaesthetic buffy layer vitamin C levels and the subsequent pains. Measurement of buffy layer and plasma vitamin C levels before and after anaesthesia did not suggest that vitamin C deficiency occurs during or immediately after administration of suxamethonium. It is concluded that the administration of vitamin C cannot be recommended as a means for prevention of suxamethonium pains.