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

Abstract

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.

Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy

“…Therefore, neuromuscular blocking agents are indispensable to relax pharyngeal muscles for supporting laryngoscope placement. Because of the fast onset and short action time, succinylcholine is an excellent neuromuscular blocking agent preferred by many anesthesiologists (Mostafa et al 2022 ), but it has many adverse effects (e.g., myalgia, fasciculations, hyperkalemia and malignant hyperthermia) (Foldes et al 1952 ), In this study, rocuronium, a rapid- and long-acting neuromuscular blocking agent, was administered to ensure a perfect neuromuscular blocking effect. Previous research has shown that the onset action time of rocuronium was approximately 60 s, but its average recovery duration was relatively long and can reach over 40 min (Khuenl-Brady and Sparr 1996 ).…”

Non-intubated deep paralysis: a new anaesthesia strategy for vocal cord polypectomy

“…Therefore, neuromuscular blocking agents are indispensable to relax pharyngeal muscles for supporting laryngoscope placement. Because of the fast onset and short action time, succinylcholine is an excellent neuromuscular blocking agent preferred by many anesthesiologists [14], but it has many adverse effects (e.g., myalgia, fasciculations, hyperkalemia and malignant hyperthermia) [15], In this study, rocuronium, a rapid-and long-acting neuromuscular blocking agent, was administered to ensure a perfect neuromuscular blocking effect. Previous research has shown that the onset action time of rocuronium was approximately 60s, but its average recovery duration was relatively long and can reach over 40 min [16].…”