Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study / Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo-cego e controlado por placebo

ABSTRACT BACKGROUND: Succinylcholine is commonly used to achieve profound neuromuscular blockade of rapid onset and short duration. OBJECTIVE: The present study compared the efficacy of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia. DESIGN: Prospective, randomized, placebo controlled, double blinded study. MATERIALS AND METHODS: Patients of both genders undergoing elective spine surgery were randomly assigned to two groups. Patients in Group P (pregabalin group) received 150 mg of pregabalin orally 1 h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5 mcg/kg, propofol 1.5-2.0 mg/kg followed by succinylcholine 1.5 mg/kg. The intensity of fasciculations was assessed by an observer blinded to the group allotment of the patient on a 4-point scale. A blinded observer recorded postoperative myalgia grade after 24 h of surgery. Patients were provided patient-controlled analgesia with fentanyl for postoperative pain relief. RESULTS: Demographic data of both groups were comparable (p > 0.05). The incidence of muscle fasciculation's was not significant between two groups (p = 0.707), while more patients in group C had moderate to severe fasciculation's compared to group P (p = 0.028). The incidence and severity of myalgia were significantly lower in group P (p < 0.05). CONCLUSION: Pregabalin 150 mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.

RESUMO JUSTIFICATIVA: A succinilcolina é comumente usada para atingir um bloqueio neuromuscular profundo, de início rápido e de curta duração. OBJETIVO: Comparar a eficácia de pregabalina na prevenção de mialgia e fasciculação induzidas por succinilcolina. DESENHO: Estudo prospectivo, randômico, duplo-cego e controlado por placebo. MATERIAIS E MÉTODOS: Pacientes de ambos os sexos submetidos a cirurgia eletiva de coluna foram aleatoriamente divididos em dois grupos. Os pacientes do Grupo P (pregabalina) receberam 150 mg de pregabalina oral uma hora antes da indução da anestesia e os pacientes do Grupo C (controle) receberam placebo. A anestesia foi induzida com fentanil (1,5 mcg/kg) e propofol (1,5-2,0 mg/kg), seguidos de succinilcolina 1,5 mg/kg. A intensidade da fasciculação foi avaliada por um observador, cego para a alocação dos grupos, com uma escala de 4 pontos. Um observador cego registrou o grau pós-operatório de mialgia após 24 horas de cirurgia. Para o alívio da dor no pós-operatório, fentanil foi usado em sistema de analgesia controlada pelo paciente. RESULTADOS: Os dados demográficos de ambos os grupos eram comparáveis (p > 0,05). A incidência de fasciculação muscular não foi significativa entre os dois grupos (p = 0,707), enquanto mais pacientes do Grupo C apresentaram fasciculação de moderada a grave em relação ao Grupo P (p = 0,028). A incidência e a gravidade da mialgia foram significativamente menores no grupo P (p < 0,05). CONCLUSÃO: Pregabalina (150 mg) previne mialgia e fasciculação induzidas por succinilcolina, além de diminur o consumo de fentanil em cirurgia eletiva de coluna.

Precurarización con rocuronio y d-tubocurarina: otra perspectiva / Precurarization with rocuronium and d-tubocurarine

Objetivo: Estudiar la precurarización de la succinilcolina utilizando d-tubocurarina y rocuronio introduciendo los métodos restrictivo, conceptos de velocidad de acción y recuperación y una nueva semiología para evaluar las fasciculaciones. Material y método: Se administraron succinilcolina (1 mg x Kg-1) (n =21) sola o precedida por rocuronio o d-tubocurarina (60 ó 50 ug x Kg-1) (n =21 c/u), determinándose: la fase inicial de comienzo hasta 80 por ciento de bloqueo, tiempo de comienzo, máximo efecto, duración clínica, tiempo de reversión espontánea entre 10 por ciento y 25 por ciento y 25 por ciento a 50 por ciento. Se calculó la velocidad de acción (inicial, final y global) como la relación tiempo/bloqueo fraccionado y la velocidad de recuperación. El método restrictivo fue empleado para el estudio del tiempo de comienzo, utilizando un rango restringido de bloqueo. Las fasciculaciones fueron evaluadas por su intensidad en seis regiones anatómicas por cuatro observadores imparciales e independientes y las medias de sus valoraciones utilizadas para analizarlas. Resultados: Aparentemente ambos desfasciculantes prolongan la fase inicial, tiempo de comienzo y velocidad de la succinilcolina, pero el método restrictivo únicamente lo confirmó para el tiempo de comienzo y la velocidad global. La velocidad inicial fue más rápida que la final. El rocuronio redujo el efecto y la duración clínica e incrementó la velocidad de recuperación de la succinilcolina. Las fasciculaciones fueron más frecuentes e intensas en el tronco y miembro superior izquierdo, pero los precurarizantes las redujeron tanto en intensidad como localización Discusión: La precurarización no modifica la fase inicial de comienzo, surgiendo la posibilidad de practicar una intubación temprana. Debido al acortamiento que provoca la precurarización con rocuronio se hace evidente la necesidad precoz de nuevas dosis de relajantes.

Objective: To study the precurarization of succinylcholine with d-tubocurarine and rocuronium, using the restrictive method, speed of action and recovery principles and a particular evaluation for fasciculations Material & Methods: Patients received succinylcholine (1 mg x Kg-1) (n =21) either alone or preceded by d-tubocurarine or rocuronium (60 ó 50 micron g x Kg-1) (n =21 e/a), and the following clinical measurements were made: earlyphase of onset time (up to 80 percent blockade), onset time, maximal block, clinical duration and recovery time between 10 percent and 25 percent and 25 percent to 50 percent. Speed of action (initial, final and global)as the ratio between time and fractional blockade and speed of recovery, were calculated. Restrictive method was used for the study of the entire onset time on patients included in a limited range of final block. Intensity of fasciculations was evaluated by four independent observers blind to the drugs used in six anatomical regions and their mean values used for analysis. Results: Apparently, precurarizing drugs prolonged initial phase, onset time and reduced speed for succinylcholine, but only onset time and global speed were confirmed by restrictive method. After rocuronium, maximal effect as well as clinical duration of succinylcholine werereduced and speed of recovery increased. Fasciculations were more frequent and intense at the trunk and left upper arm, but precurarization reduced both intensity and localization prevalence. Discussion: As lack of changes on the initial phase of onset time for succinylcholine inducedby precurarization was noticed, an early tracheal intubation could be contemplated. Due to reduction on clinical duration after rocuronium,new doses of muscle relaxants are sooner necessary. The present method for evaluation of fasciculations shows how far they are spread and how effective precurarization was, given rise to doubts on previous results.

Can lidocaine reduce succinylcholine induced postoperative myalgia?

This study was undertaken to determine the effect of lidocaine pretreatment on reduction of succinylcholine-induced myalgia in patients undergoing general anesthesia for gynecological surgery. One hundred and thirty-five patients were assigned to one of three groups in a prospective, double blind, randomized manner. Group PS, the control group, received normal saline and succinylcholine 1.5 mg x kg(-1); Group LS, lidocaine 1.5 mg x kg(-1) and succinylcholine 1.5 mg x kg(-1); Group PR, normal saline and rocuronium 0.6 mg x kg(-1). Morphine 0.1 mg x kg(-1) iv was given for premedication and all patients were monitored with a noninvasive blood pressure monitor, ECG and pulse oximetry. Anesthesia was induced with 5 mg.kg(-1) thiopental iv. followed by succinylcholine (Group PS, LS) or rocuronium (Group PR) for tracheal intubation. Following administration of these agents, the presence, and degree of fasciculation were assessed visually on a four point scale by one investigator who was blinded to the drug administered. The blood pressure and heart rate of each patient were monitored on nine occasions. Twenty-four hours later, any myalgia experienced was assessed according to a structured questionaire and graded by a four point scale by one investigator blinded to the intraoperative management. The results indicate that muscle fasciculation was not found in Group PR while the patients in Group LS had a lower incidence of muscle fasciculation than those in Group PS (p < 0.001). At 24 h, the incidence of myalgia was higher in Group PS than in Group LS and PR (p < 0.05). A correlation was not found between the incidence of myalgia and the occurrence of muscle fasciculation. The changes in systolic and diastolic blood pressure and heart rate were not significant among the three groups. In conclusion, where succinylcholine is used, lidocaine is proven to be the useful pretreatment agent for the reduction of postoperative myalgia.

Effect of lidocaine, atracurium and diazepam pretreatments on post-suxamethonium muscle fasciculations and intubating conditions

This study was designed to evaluate the effect of lidocaine, atracurium and diazepam pretreatments on the incidence and severity of post-suxamethonium muscle fasciculations and on the intubating conditions. 200 patients of both sexes undergoing different surgical procedures were subjected to this study. These patients were divided into four equal groups. All patients were premedicated 30 minutes before induction of anaesthesia by 0.01 mg/kg IM. Two minutes before induction 5 cc saline [as placebo], 3 mg/kg lidocaine, 2.5 mg atracurium and 5 mg diazepam were injected intravenously in the 1st [control], 2nd, 3rd and 4th group respectively. Anaesthesia was induced by thiopentone Na [5 mg/kg] intravenously followed by IV administration of 1 mg/kg suxamethonium to facilitate endotracheal intubations and it was maintained under halothane and oxygen. After suxamethonium administration, the incidence and the severity of muscle fasciculations beside the intubating conditions were evaluated and recorded in a double blind fashion among the patients of this study. From this study it was found that all pretrearments reduced both the incidence and severity of muscle fasciculations. The most effective one was atracurium followed by lidocaine and then by diazepam pretreatment. Numerically but not statistically. intubating conditions were the best in lidocaine pretreated group followed by control group then by diazepam pretreated group and lastly by atracurium pretreated one

Diazepam näo previne as fasciculaçöes produzidas pela succinilcolina: estudo comparativo entre diazepam e pancurônio / Diazepam does not prevent succinylcholine-induced fasciculations: a comparative evaluation of the effects of diazepam and pancuronium pretreatments

Para avaliar a capacidade do diazepam em prevenir as fasciculaçöes produzidas pela succinilcolina (SCh), 90 pacientes foram estudados e divididos em três grupos. Pacientes do grupo 1 näo receberam nenhuma medicaçäo e serviram de grupo controle. Pacientes do grupo 2 foram pré-tratados com diazepam 0,1 mg.kg 3 min antes da administraçäo de SCh, enquanto que os pacientes de grupo 3 foram pré-tratados com pancurônio 0,015 mg.kg 3 min antes da SCh. A dosagem de SCh foi de 1,0 mg.kg nos grupos 1 e 2 e de 1,5 mg.kg no grupo 3. Fasciculaçäo e condiçäo de intubaçäo foram avaliadas em todos os grupos. A fasciculaçäo apareceu em 93% dos pacientes do grupo controle e em 17% no grupo do pancurônio, enquanto que o diazepam se mostrou ineficaz na prevençäo da freqüência e intensidade das fasciculaçöes. As condiçöes de intubaçäo foram consideradas adequadas em todos os pacientes dos três grupos. Concluindo, o pré-tratamento com o pancurônio é um método efetivo na prevençäo da fasciculaçäo enquanto que o diazepam se mostrou ineficaz na prevençäo desta fasciculaçäo

Prevención de las fasciculaciones musculares provocadas por succinilcolina, mediante la administración previa de vecuronium (ORG NC-45) / Prevention of muscular fasciculations induced by succinylcholine by means of previous administration of vecuronium (ORG NC-45)

En 30 pacientes se administraron 1, 0, 6 y 0,3 mg de Vecuronium (NC-45) tres minutos antes de inyectar 1 mg. Kg.1 de peso de Succinilcolina, con la finalidad de constatar su capacidad de inhibir las fasciculaciones características producidas por la administración de este último relajante muscular. La dosis de 1 mg de NC-45 evidenció ser totalmente efectiva para inhibir las fasciculaciones, pero 9 de los 10 pacientes presentaron ptosis palpebral de magnitud variable, y dos manisfestaron dificultad respiratoria. Con 0,6 mg de NC-45 se logró inhibir las fasciculaciones en 8 de los 10 pacientes, pero hubo ptosis palpebral en 3 de ellos. La dosis de 0,3 mg de NC-45 se mostró insuficiente como antifasciculatoria. De acuerdo a estos resultados, se hace evidente la dificultad de dosificar adecuadamente el Norcuron como agente antifasciculatorio de la Succinilcolina. Este hecho posiblemente está relacionado con la mayor potencia farmacológica de la droga. Por lo cual consideramos que el NC-45 no ofrece ventajas sobre otros relajantes no despolarizantes empleados con la finalidad de prevenir las fasciculaciones por Succinilcolina