Effects of nitric oxide on C2C12 cell inflammatory responses and notexin-induced muscle injury / Efectos del óxido nítrico en las respuestas inflamatorias de las células C2C12 y la lesión muscular inducida por notexina

SUMMARY: Skeletal muscle injury is an acute inflammatory condition caused by an inflammatory response. To reduce inflammatory cell infiltration and relieve skeletal muscle injury, efficient treatment is urgently needed. Nitric oxide is a free radical molecule reported to have anti-inflammatory effects. In this study, we showed that NO could inhibit the inflammatory response of C2C12 cells in vitro and protect rat skeletal muscle injury from notexin in vivo. NO synthase inhibitor (L-NG-Nitroarginine Methyl Este?L-NAME) and NO donor (sodium nitroprusside dehydrate ?SNP) were used to explore the vital role of lipopolysaccharides (LPSs) in LPS-stimulated C2C12 myoblasts.The expression of IL-18 and IL-1b was upregulated by L-NAME and downregulated by SNP, as indicated by the ELISA results. NO can reduce ASC, Caspase-1, and NLRP3 mRNA and protein levels. Furthermore, NO was detected in the rat model. The results of immunohistochemical staining showed that the production of DMD decreased. We conducted qRT-PCR and western blotting to detect the expression of Jo-1, Mi-2, TLR2, and TLR4 on day 6 post injury following treatment with L-NAME and SNP. The expression of Jo-1, Mi-2, TLR2, and TLR4 was upregulated by L-NAME and significantly reversed by SNP. NO can alleviate C2C12 cell inflammatory responses and protect rat skeletal muscle injury from notexin.

RESUMEN: La lesión del músculo esquelético es una afección inflamatoria aguda causada por una respuesta inflamatoria. Para reducir la infiltración de células inflamatorias y aliviar la lesión del músculo esquelético es necesario un tratamiento eficaz. El óxido nítrico es una molécula de radicales libres que tiene efectos antiinflamatorios. En este estudio, demostramos que el ON podría inhibir la respuesta inflamatoria de las células C2C12 in vitro y proteger la lesión del músculo esquelético de rata de la notexina in vivo. El inhibidor de ON sintasa (L-NG-nitroarginina metil este, L-NAME) y el donante de ON (nitroprusiato de sodio deshidratado, SNP) se utilizaron para explorar el papel vital de los lipopolisacáridos (LPS) en los mioblastos C2C12 estimulados por LPS. La expresión de IL- 18 e IL-1b fue regulada positivamente por L-NAME y regulada negativamente por SNP, como indican los resultados de ELISA. El ON puede reducir los niveles de proteína y ARNm de ASC, Caspasa-1 y NLRP3. Además, se detectó ON en el modelo de rata. Los resultados de la tinción inmunohistoquímica mostraron que disminuyó la producción de DMD. Realizamos qRT-PCR y transferencia Western para detectar la expresión de Jo-1, Mi-2, TLR2 y TLR4 el día 6 después de la lesión después del tratamiento con L-NAME y SNP. La expresión de Jo-1, Mi-2, TLR2 y TLR4 fue regulada positivamente por L- NAME y significativamente revertida por SNP. El ON puede aliviar las respuestas inflamatorias de las células C2C12 en ratas, y proteger la lesión del músculo esquelético de la notexina.

A case report of colchicine-induced myopathy in a patient with chronic kidney disease / 北京大学学报(医学版)

Colchicine plays an important role in the treatment of gout and some other diseases. Besides gastrointestinal symptoms, myopathy has been reported as a rare side effect of colchicine in some patients. We report a case of myopathy in a patient with chronic kidney disease caused by high-dose colchicine, and then review literature on colchicine-induced myopathy, so as to provide some experience for the clinical diagnosis, treatment and medication safety. A 51-year-old male patient with 10 years of gout and 5 years of chronic kidney disease history and irregular treatment was admitted to the hospital with complaint of recurrent left wrist arthralgia and emerging lower extremities myalgia after intake of 40-50 mg colchicine in total within 20 days. Laboratory examinations showed significantly increased creatine kinase (CK) and then colchicine-induced myopathy was diagnosed preliminarily. After withdrawl of colchicine and implementation of hydration, alkalization and intramuscular injection of compound betamethasone, the symptoms of arthralgia and myalgia were relieved within 3 days and CK decreased to normal range gradually. According to literature reports, colchicine related myopathy was mostly characterized by proximal myasthenia and myalgia, accompanied by elevated CK level, which usually occurred days to weeks after initial administration of colchicine at the usual dosage in patients with renal impairment or a change in the underlying disease state in those receiving long-term therapy, and the features might remit within three to four weeks after the drug was discontinued. Electromyography of proximal muscles showed myopathy marked by abnormal spontaneous activity and muscle pathology waa marked by accumulation of lysosomes and autophagic vacuoles. Chronic kidney disease, liver cirrhosis, higher colchicine dose and concomitant cytochrome P450 3A4 (CYP3A4) inhibitors were associated with increased risk of myo-pathy. Based on the similar efficacy and lower adverse reaction rate compared with larger dosage, small dose of colchicine was recommended by many important current guidelines and recommendations in the treatment of gout. In consideration of potential risks, colchicine should be used with caution in patients with kidney or liver impairment, and in those taking CYP3A4 or P-glycoprotein inhibitors. For those patients, the drug dose should be adjusted and the latent adverse reactions should be monitored carefully.

Association between the use of a baby's bottle and pacifier and the absence of breastfeeding in the second six months of life / Associação entre o uso de mamadeira e de chupeta e a ausência de amamentação no segundo semestre de vida

Introduction: The World Health Organization recommends breastfeeding for two years or more and advises against bottle feeding and pacifier use. Objective: Investigate the association between bottle feeding and pacifier use, and breastfeeding in the second half-year of life. Methods: Survey in a municipality of Rio de Janeiro state, in 2006, interviewing those responsible for 580 children aged 6-11 months. Bottle feeding and pacifier use, and variables which in the bivariate analysis were associated with the outcome 'absence of breastfeeding' (≥ 0.20), were selected for multiple analysis. Adjusted prevalence ratios were obtained by a Poisson regression model. Results: 40% of the children 6-11 months were not being breastfed, 47% used a pacifier and 57% used a bottle. Pacifier use (PR = 3.245; CI95%: 2.490-4.228) and bottle feeding (PR = 1.605; CI95%: 1.273-2.023) were shown to be strongly associated with the outcome, and also with: mother's low schooling (PR = 0.826; CI95%: 0.689-0.990); low birth weight (PR = 1.488; CI95%: 1.159-1.910); mother not being the baby carer (PR = 1.324; CI95%: 1.080-1.622); and increasing age of the baby in days (PR = 1.004; CI95%: 1.002-1.006). Conclusions: The use of pacifiers and bottles can reduce continued breastfeeding. Stronger discouragement of these artifacts should be adopted in public health policies. .

A OMS preconiza a amamentação por 2 anos ou mais e contraindica o uso de chupeta e mamadeira. O objetivo deste estudo foi investigar a associação entre esse uso e o aleitamento materno no 2º semestre de vida, por meio de inquérito. Foi conduzido em município do estado do Rio de Janeiro, em 2006, entrevistando acompanhantes de 580 crianças de 6 a 11 meses. O uso da chupeta e da mamadeira e variáveis, que na análise bivariada se associaram ao desfecho "ausência do aleitamento materno" (≥ 0,20), foram selecionadas para análise múltipla. Razões de prevalência ajustadas foram obtidas por modelo de regressão de Poisson com variância robusta. Não estavam sendo amamentadas 40% das crianças de 6 a 11 meses, 47% usavam chupeta e 57% mamadeira. O uso de chupeta (RP = 3,245; IC95%: 2,490-4,228) e da mamadeira (RP = 1,605; IC95%: 1,273-2,023) mostraram-se fortemente associados ao desfecho, além da: baixa escolaridade materna (RP = 0,826; IC95%: 0,689-0,990), baixo peso ao nascer (RP = 1,488; IC95%: 1,159-1,910), mãe não ser o acompanhante do bebê (RP = 1,324; IC95%: 1,080-1,622), e idade crescente do bebê em dias (RP = 1,004; IC95%: 1,002-1,006). O uso de chupetas e mamadeiras pode prejudicar a amamentação continuada. O desestímulo a estes artefatos deve ser reforçado no âmbito das políticas públicas de nutrição e saúde.

Treatment of Dyslipidemia with Statins and Physical Exercises: Recent Findings of Skeletal Muscle Responses / Tratamento das Dislipidemias com Estatinas e Exercícios Físicos: Evidências Recentes das Respostas Musculares

Statin treatment in association with physical exercise practice can substantially reduce cardiovascular mortality risk of dyslipidemic individuals, but this practice is associated with myopathic event exacerbation. This study aimed to present the most recent results of specific literature about the effects of statins and its association with physical exercise on skeletal musculature. Thus, a literature review was performed using PubMed and SciELO databases, through the combination of the keywords “statin” AND “exercise” AND “muscle”, restricting the selection to original studies published between January 1990 and November 2013. Sixteen studies evaluating the effects of statins in association with acute or chronic exercises on skeletal muscle were analyzed. Study results indicate that athletes using statins can experience deleterious effects on skeletal muscle, as the exacerbation of skeletal muscle injuries are more frequent with intense training or acute eccentric and strenuous exercises. Moderate physical training, in turn, when associated to statins does not increase creatine kinase levels or pain reports, but improves muscle and metabolic functions as a consequence of training. Therefore, it is suggested that dyslipidemic patients undergoing statin treatment should be exposed to moderate aerobic training in combination to resistance exercises three times a week, and the provision of physical training prior to drug administration is desirable, whenever possible.

A associação do tratamento medicamentoso por estatinas com a prática de exercícios físicos pode reduzir substancialmente o risco de mortalidade cardiovascular de indivíduos dislipidêmicos, porém sua realização vem sendo associada à exacerbação de quadros miopáticos. O presente trabalho teve como objetivo apresentar os resultados mais recentes da literatura específica sobre os efeitos da associação de estatinas ao exercício físico na musculatura esquelética. Para tanto, realizou-se levantamento da literatura nas bases de dados PubMed e SciELO, utilizando a combinação dos unitermos: “estatina/estatinas” AND “exercício” AND “músculo” (“statin” AND “exercise” AND “muscle”), sendo selecionados apenas artigos originais publicados entre janeiro de 1990 e novembro de 2013. Foram analisados 16 artigos que avaliaram o efeito da associação das estatinas com exercício agudo ou crônico na musculatura esquelética. Os resultados dos estudos apontaram que atletas podem experimentar efeitos deletérios na musculatura esquelética quando do uso de estatinas, visto que os quadros de exacerbação da lesão muscular pelo exercício foram mais frequentes com treinamento intenso ou exercícios agudos excêntricos e extenuantes. O treinamento físico moderado, por sua vez, quando associado às estatinas, não aumenta os relatos de dor nem os níveis de creatina quinase, além de acarretar ganhos nas funções musculares e metabólicas advindas do treinamento. Sugere-se, portanto, que pacientes dislipidêmicos em tratamento com estatinas sejam expostos ao treinamento físico aeróbio combinado a exercícios resistidos, de intensidade moderada, em três sessões semanais, sendo que a oferta do treinamento físico previamente à administração do tratamento medicamentoso, quando possível, faz-se desejável.

Antiviral Effect of Entecavir Switching Therapy in Chronic Hepatitis B Patients with Clevudine-associated Myopathy / 대한소화기학회지

No abstract available.

Efficacy of Entecavir Switching Therapy in Chronic Hepatitis B Patients with Clevudine-induced Myopathy / 대한소화기학회지

BACKGROUND/AIMS: Clevudine is a potent antiviral agent against HBV. However, long-term clevudine therapy may cause myopathy. This study was carried out to identify the efficacy of entecavir switching therapy in chronic hepatitis B patients experiencing clevudine-induced myopathy. METHODS: One hundred forty six patients with chronic hepatitis B treated with 30 mg of clevudine per day for 73 weeks (range, 36-132 weeks) were enrolled. Among them, clevudine-induced myopathy occurred in 21 patients (14.4%) which was diagnosed if the patients had symptoms related to myopathy with concurrent CK and AST elevation. All the patients who were diagnosed as clevudine-induced myopathy stopped the therapy, and 17 patients (81%) were switched to entecavir 0.5 mg. RESULTS: The patients with clevudine-induced myopathy were switched to entecavir 0.5 mg for median 68 weeks, and all of them showed disappearance of clinical myopathic symptoms and normalization of CK and AST level within median 2.2 months. Eight patients (47%) were HBeAg positive before entecavir treatment, and HBeAg seroconversion was achieved in 2 patients (25%). HBV DNA level was elevated in 3 patients (17.6%) at the time when the patients were diagnosed as myopathy, all of them achieved virological response with entecavir switching therapy. ALT level was elevated in 3 patients (17.6%) before entecavir treatment, all of them showed normalization of ALT level. During entecavir therapy, genotypic resistance to entecavir or virological breakthrough was not noted. CONCLUSIONS: In chronic hepatitis B patients experiencing clevudine-induced myopathy, switching to entecavir 0.5 mg per day showed a resolution of myopathy and adequate viral suppression.

Miopatía necrotizante autoinmune (NAM): a propósito de un caso clínico / Necrotizing autoimmune myopathy (NAM): a propos of a clinical case

La miopatía inducida por estatinas es una reacción adversa que limita el uso de estos fármacos. Si bien su incidencia es baja, puede asociarse a cuadros severos e invalidantes. Habitualmente la miopatía es autolimitada y mejora con la suspensión del hipolipemiante, pero se han descrito casos en que el daño es persistente. en muchos de estos casos, la biopsia ha permitido demostrar una nueva entidad, denominada Miopatía Necrotizante Autoinmune (NAM) por estatinas, la cual se relaciona a una sobreexpresión del complejo mayor de histocompatibilidad tipo I y a la presencia de anticuerpos anti-HMGCoA reductasa. La NAM inducida por estatinas es una condición que responde al tratamiento esteroidal e inmunosupresor, pero puede dejar importantes secuelas. Por tal razón, su detección precoz y adecuado tratamiento resultan fundamentales. Presentamos el caso clínico de una mujer con esta entidad que refleja la dificultad diagnóstica y terapéutica.

Statins induced myotoxicity, constitutes sometimes a major barries to the use of these drugs. Although a low incidece, may be associated with severe disease and disability. Usually this myopathy is self-limited and improves with the removal of lipid-lowering agent, but has been reported patients with persistent disease. In many of this cases, the muscle biopsy has demonstrated a new entity called autoimmune necrotizing myopathy (NAM) for statins, which is characterized by an up-regulation of major histocompatibility complex type I (MHC I) and the presence of anti-HMGCoA reductase antibodies. NAM caused by statins in difficult to manage and can cause important damage. by this reason, early detection and treatment is crucial. We report a case of a woman with this condition, which reflects the difficulty in diagnosis and therapy.

Cerebellar Nocardiosis and Myopathy from Long-Term Corticosteroids for Idiopathic Thrombocytopenia

Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.

Efeitos indesejáveis dos hipolipemiantes: condutas na prática clínica: [revisão] / Adverse effects of hypolipemic drugs: how to treat in clinical practice: [review]

Os fármacos hipolipemiantes, apesar de diminuírem a morbimortalidade por doença coronariana, não são destituídos de efeitos indesejáveis. Estes freqüentemente são transitórios, mas podem ocorrer alterações clínicas e laboratoriais que exigem especial atenção e diferentes condutas. Neste artigo, os autores relatam fundamentalmente como proceder diante do comprometimento muscular e hepático, considerados efeitos adversos mais relevantes dos hipolipemiantes. De modo sucinto, apontam os demais efeitos e a respectiva conduta.

Hypolipemic drugs improve coronary morbidity and mortality and appear to be safe; nevertheless appropriate monitoring is recommended. Adverse effects are reported that are frequently transitory. Severe adverse effects are infrequent, but clinicians must correctly screen them; symptoms and laboratory changes must be carefully interpreted. Often they call for special treatment and replacement of the hypolipemic drugs in use. This article emphasizes how to treat dyslipidemia if skeletal muscle and liver involvement are present. Briefly other adverse effects are also reported.

Artropatias iatrogênicas droga-induzidas / Iatrogenic drug-induced arthropathy

Um grupo de pacientes idosos apresenta várias doenças, levandoa consumir inúmeras drogas. Por outro lado, o metabolismo dessasdrogas se encontra bastante alterado pelas condições especiais doprocesso de envelhecimento. Portanto, um determinado sintoma aser combatido pode não ser causado pela devida doença, mas sim,por algum tipo de droga que o paciente esteja usando. Este capítulotem como escopo enumerar as síndromes reumáticas que podem seruma conseqüência das várias drogas administradas aos idosos.

Cassia occidentalis poisoning as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh.

BACKGROUND & OBJECTIVE: Recurrent annual outbreaks of acute encephalopathy illness affecting young children have been reported for several years in many districts of western Uttar Pradesh (UP). Our earlier investigations over three consecutive years (2002-2005) proved that these outbreaks were due to a fatal multi-system disease (hepatomyoencephalopathy syndrome) probably caused by some phytotoxin and not due to viral encephalitis as believed so far. We conducted a case-control study to investigate the risk, if any, from various environmental factors and also to identify the putative toxic plant responsible for development of this syndrome. METHODS: Eighteen cases with acute hepatomyoencephalopathy syndrome admitted in 2005 in a secondary care paediatric hospital of Bijnor district of western UP were included in the study. Three age-matched controls were selected for each case. A semi-structured questionnaire was developed and applied to all 18 cases and 54 controls. All interviews were conducted within one week of discharge or death of each case. Quantitative data were analyzed using the relevant established statistical tests. RESULTS: Parents of 8 (44.4%) cases gave a definite history of their children eating beans of Cassia occidentalis weed before falling ill, compared with 3 (5.6% controls), the odds ratio being 12.9 (95% CI 2.6-88.8, P<0.001). History of pica was the other associated factor with the disease, odds ratio 5.20 (95% CI 1.4-19.5, P<0.01). No other factor was found significantly associated with the disease. INTERPRETATION & CONCLUSION: Consumption of C. occidentalis beans probably caused these outbreaks, described earlier as hepatomyoencephalopathy syndrome. Public education has the potential to prevent future outbreaks.

Toxic myopathies: muscle biopsy features

Several drugs and toxic substances can cause muscular abnormalities and are frequent causes of acquired myopathies. We present a series of 32 patients, predominance of young adult patients, diagnosed with toxic myopathy. The most common substances inducing myopathy were corticosteroids (56.2 percent) followed by the propoxyphene, neuroleptics, zidovudine and drug-induced hypokalemia. The investigation showed normal serum creatine kinase levels in 65.4 percent, myopathic pattern of the needle electromyography in 40 percent and the more frequent histological diagnosis of the muscle biopsy was type 2 fiber atrophy (59.3 percent). Clinical features, etiology, course of the disease, serum levels of muscular enzymes, electromyographic features and, especially, muscle biopsy features are discussed.

Diversos medicamentos e substâncias tóxicas podem causar alterações musculares e são causas freqüentes de miopatia adquirida. Apresentamos uma série de 32 pacientes, predomínio de pacientes adulto jovens, com miopatia tóxica. As substâncias mais relacionadas com a miopatia foram os corticosteróides (56,2 por cento) seguidos pelo propoxifeno, neurolépticos, zidovudina e drogas indutoras de hipocalemia. A investigação mostrou níveis normais de creatino quinase sérica em 65,4 por cento, eletromiografia de agulha com padrão miopático em 40 por cento e o mais freqüente diagnóstico histológico da biópsia muscular foi atrofia de fibras do tipo 2 (59,3 por cento). As manifestações clínicas, etiologia, tempo de evolução, nível sérico das enzimas musculares, alterações da eletroneuromiografia e, especialmente, da biópsia muscular são discutidos.

Pravastatin induced myopathy

Lipid-lowering agents such as HMG-CoA reductase inhibitors [also known as statin drugs] are generally well tolerated. But a recognized side effect still can happen, We report a case of 47-year-old Iraqi male patient previously known hypothyroid, was not on replacement therapy, as he did not appear after his thyroid functions was checked came in with severe body pain for 10 months got worse in the last three months, started on lipostat [ten months ago] found to have myopathy as evident by high CPK which improved gradually clinically and biochemical after stopping lipostat

Farmacocinética das estatinas / Pharmacokinetics of statins

As estatinas são agentes hipolipemiantes que exercem os seus efeitos através da inibição da HMG-CoA redutase, enzima fundamental na síntese do colesterol, levando a uma redução do colesterol tecidual e um conseqüente aumento na expressão dos receptores de LDL. Existem consideráveis diferenças entre as estatinas, no que tange às propriedades farmacocinéticas, bem como ao coeficiente de hidrofilicidade, via hepática de metabolização (especialmente, do citocromo P450 e isoenzimas), meia-vida plasmática e eficácia na redução lipídica. As estatinas também podem diferir na capacidade de interação com outras drogas que utilizam a mesma via de metabolização. Recentemente, muitos efeitos pleiotrópicos têm sido relatados com estas drogas, bem como propriedades antiinflamatórias, melhora na função endotelial e benefícios na hemostasia.

Sodium valproate -- induced skeletal myopathy.

The authors report a case of skeletal myopathy in a four-year-old boy on long-term sodium valproate therapy for secondary epilepsy due to neurocysticercosis. He presented with clinical features of limb girdle weakness. EMG revealed features of myopathy. Carnitine deficiency due to sodium valproate was suspected and plasma carnitine levels were found to be low. Sodium valproate was withdrawn. L-carnitine supplementation resulted in marked clinical recovery as well as rise in plasma carnitine levels.

Statin and fibrate associed myopathy: study of eight patients

As drogas redutoras de colesterol são ocasionalmente associadas a sintomas neuromusculares e alterações morfológicas observadas na biopsia muscular. Relatamos o curso clínico e achado da biopsia muscular em oito pacientes com hiperlipoproteinemia tratados com drogas redutoras de colesterol (estatinas/fibratos). Cinco pacientes tiveram mialgia e em dois havia fraqueza muscular proximal. Todos os pacientes ficaram assintomáticos após retirada da medicação embora a creatinoquinase permanecesse elevada. Analisamos a biopsia muscular em seis casos realizados entre três meses e dois anos após a suspensão da droga. Encontramos variação no calibre das fibras em todos os casos com necrose de fibras em cinco, infiltrado inflamatório em um caso, presença de vacúolos em um e "ragged red fiber" em três deles. Concluímos que, embora os achados da biopsia muscular não fossem específicos, o uso prolongado de estatinas e/ou fibratos pode induzir a uma miopatia crônica até mesmo na ausência de sintomas.

Fenofibrate-induced myopathy.

Fenofibrate induced myopathy is a rare adverse event. We present a case of muscle pain and quadriparesis following administration of 200mg of fenofibrate for 35 days. Patient gradually improved after stopping the drug. As per our knowledge, this is probably the first case report of fenofibrate induced myopathy from India.

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.