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Prevention of succinylcholine-related fasciculations and myalgia. A systematic review of randomized trials: A-23

Schreiber, J. U.; Lysakowski, C.; Fuchs-Buder, T.; Tramér, M. R.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 7
Evidence Based Practice and Quality Assurance

Department of Anesthesiology, University of Saarland, Homburg, Germany

Background and Goal of Study: Succinylcholine is often used for rapid sequence induction (1). Fasciculation and myalgia are frequent succinyl-choline-related adverse effects. The relative efficacy of pharmacological pretreatments to prevent these adverse effects remains unclear (2).

Materials and Methods: Extensive search for full reports of randomized trials (to 2.2004) that tested pretreatments vs. placebo for the prevention of succinylcholine-related fasciculation and myalgia. Dichotomous data on fasciculation, myalgia, and pretreatment-related adverse effects were combined using a fixed effect model.

Results and Discussions: 52 trials (5,318 patients) tested a large variety of pretreatments. In control groups, the average incidence of fasciculation was 95%, and of myalgia at 24 hours was 50%. No relationship between incidence of fasciculations and incidence of myalgia was found. Low-dose nondepolarizing myorelaxants, sodium-channel-blockers (lidocaine, phenytoin), and magnesium were most effective in preventing fasciculation (number-needed-to-treat, 1.5 to 2.5). Best prevention of myalgia after 24 hours was with low-dose rocuronium or gallamine and sodium-channel-blockers (number-needed-to-treat, 3), and with non-steroidal anti-inflammatory drugs (number-needed-to-treat, 2.5). With low-dose myorelaxants there was an increased incidence of blurred vision, weakness, and difficulty in swallowing and breathing.

Conclusion: Low-dose myorelaxants, magnesium and sodium channelblockers may be used to prevent succinylcholine-related fasciculation. Nonsteroidal anti-inflammatory drugs are most efficacious for the prevention of myalgia. With low-dose non-depolarizing myorelaxants, there is a finite risk of potentially serious paralyzing adverse effects.

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1 Hofmockel R. et al., Anaesthesist 2003; 52: 516-21.
2 Wong SF. et al., Anaesthesia 2000; 55: 144-52.
© 2005 European Society of Anaesthesiology