Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study

Srivastava, VK; Agrawal, Sanjay; Nimbhorkar, Vikrant K.; Mishra, Abhishek; Sharma, Sunil; Panda, P. K.

doi:10.1016/j.bjane.2014.08.004

Cited by 5 publications

(9 citation statements)

References 22 publications

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“…POM after succinylcholine administration is a common and troublesome clinical problem found most frequently on the first postoperative day. The exact pathophysiology for succinylcholine-induced myalgia is not clear and a large variety of pretreatments were tested to avoid or decrease POM (4,13). The adverse effects related to succinylcholine, such as life-threatening hyperkalemia, are more common in the presence of certain comorbidities and thus preclude its use in such situations.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size calculation was based on the previous literature (3)(4)(5), where the incidence of postoperative muscle pain in outpatients was over 70%, and an intervention that could reduce this incidence by 50% would be of interest. Using G*Power 3 software (11) with a study power of 90% and type I error of 5%, 37 patients in each group were required (α = 0.05 and β = 90%).…”

Section: Randomization Blinding and Drug Codingmentioning

confidence: 99%

“…The accurate underlying mechanism of muscle pain induced by succinylcholine is unknown, but it is believed that many mechanisms, including the increased intramuscular calcium concentration, the deterioration of the membrane phospholipid, the release of free fatty acids, and free radicals, are thought to be the causal factors (3). Various pretreatment methods were used in an attempt to diminish the intensity of POM caused by succinylcholine, including benzodiazepines, non-depolarizing muscle relaxants, local anesthetics, ketorolac, vitamin E derivatives, phenytoin, chlorpromazine, rocuronium, and remifentanil (4). Administration of succinylcholine frequently causes POM, a common troublesome symptom, which is associated with muscle damage and elevated musclerelated enzymes (5).…”

mentioning

confidence: 99%

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

et al. 2021

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BACKGROUND: 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. OBJECTIVES: 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. STUDY DESIGN: A prospective randomized controlled double-blind clinical study. SETTING: Assiut University Hospitals. METHODS: 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. RESULTS: 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. LIMITATIONS: 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. CONCLUSIONS: 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. KEY WORDS: Adult sinuscopy, fasciculation, postoperative myalgia, succinylcholine, selenium

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Section: Discussionmentioning

confidence: 99%

Section: Randomization Blinding and Drug Codingmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2021

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“…Todavia, há relatos de broncoespasmo em pacientes asmáticos, principalmente na doen-origem da mialgia é multifatorial e sua correlação com a fasciculação não é direta. 63 Administração de 10% da DE95 de BNM adespolarizantes 2-3 minutos antes do uso da succinilcolina demonstrou reduzir fasciculações e a gravidade da mialgia, sendo que o rocurônio e o pancurônio foram os mais eficazes, com NNT de seis e três, respectivamente. 62,64,65 Já o pré-tratamento com anti-inflamatório não esteroidal, lidocaína, gabapentina e pregabalina foram capazes de reduzir significativamente a mialgia em ensaios recentes.…”

Section: Efeitos Respiratóriosunclassified

“…62,64,65 Já o pré-tratamento com anti-inflamatório não esteroidal, lidocaína, gabapentina e pregabalina foram capazes de reduzir significativamente a mialgia em ensaios recentes. 63 Durante a instalação do bloqueio despolarizante, há aumento de 0.5 a 1 mEq/L da concentração plasmática de potássio com pico em três a quatro minutos. Em situações de denervação ou imobilização prolongada, a proliferação de receptores extrajuncionais do tipo α7 promove efluxo acentuado de potássio, que pode atingir níveis séricos imprevisíveis e ameaçadores à vida.…”

Section: Efeitos Respiratóriosunclassified

Adversities related to neuromuscular blockade and reversal

Alencar¹,

Louzada²,

Jorge³

et al. 2016

Revista Médica De Minas Gerais

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RESUMO Evento adverso relacionado a um fármaco é definido, pela Organização Mundial de Saúde, como uma resposta nociva e não intencional a uma droga que ocorre após o uso de doses normalmente utilizadas no homem para profilaxia, diagnóstico ou tratamento de uma doença ou para modificação de uma função fisiológica. Os bloqueadores neuromusculares (BNM) são fármacos capazes de provocar alterações indesejáveis em doses habituais e a interação com outras drogas utilizadas durante a anestesia pode potencializar, prolongar ou reverter precocemente o relaxamento neuromuscular desejado. O processo de reversão do bloqueio não é isento de riscos e complicações. Eventos adversos podem ocorrer desde o momento da administração de drogas reversoras até o período pós-operatório, no qual pode ocorrer paralisia residual. É importante reconhecer os possíveis efeitos adversos associados ao uso dessas drogas, uma vez que a escolha do BNM adequado para cada situação irá afetar diretamente o desfecho do ato anestésico.

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

et al. 2021

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Background: 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. Methods: This randomized double-blinded trial involved controlled 70 adult participants scheduled for elective direct microlaryngoscopic surgeries. Before induction of general anesthesia by 2 h, 35 patients received duloxetine 30 mg 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 24 h after surgery, patients' satisfaction, and adverse effects were recorded.Results: 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 30 min and 24 h, respectively (p value < 0.05). Sedation scores and patients' satisfaction were better in duloxetine group (p value < 0.05) with no severe complications.Conclusions: Preoperative oral duloxetine 30 mg 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.

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Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study

Abstract: Pregabalin 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

Cited by 5 publications

References 22 publications

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

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

Adversities related to neuromuscular blockade and reversal

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

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