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Vélez PA, Lara-Erazo V, Caballero-Lozada AF, Botero A, Lozada G, Velásquez AF, Villegas LM, Zorrilla-Vaca A. Preoperative pregabalin prevents succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023:S2341-1929(23)00134-8. [PMID: 37673208 DOI: 10.1016/j.redare.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/15/2022] [Indexed: 09/08/2023]
Abstract
Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction; however, its use is associated with fasciculation and myalgia. We performed a systematic review and meta-analysis of randomized controlled clinical trials comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included with a total of 481 patients - 241 in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR = 0.69, 95% CI 0.56-0.84, P < .001), which remained statistically significant for pregabalin (RR = 0.71, 95% CI 0.54-0.93, P = .013) and gabapentin (RR = 0.61, 95% CI 0.45-0.82, P = .001) separately. There was no difference in fasciculations between the groups (RR = 0.92, 95% CI 0.82-1.03, P = .148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24 h of surgery.
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Affiliation(s)
- P A Vélez
- Department of Anesthesiology, Universidad del Valle, Cali, Colombia
| | - V Lara-Erazo
- Anesthesiology Research Department, Mass Eye & Ear Institute, Harvard Medical School, Boston, MA, USA.
| | | | - A Botero
- Department of Anesthesiology, Universidad del Valle, Cali, Colombia
| | - G Lozada
- Department of Anesthesiology, Mass Eye & Ear Institute, Harvard Medical School, Boston, MA, USA
| | - A F Velásquez
- Department of Anesthesiology, Universidad del Valle, Cali, Colombia
| | - L M Villegas
- Department of Anesthesiology, Universidad del Valle, Cali, Colombia
| | - A Zorrilla-Vaca
- Department of Anesthesiology, Universidad del Valle, Cali, Colombia; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Mostafa MF, Ali Ibraheim O, Ibrahim AK, Ibrahim RAE, Herdan R. Impact of duloxetine on succinylcholine-induced postoperative myalgia after direct microlaryngoscopic surgeries: Randomized controlled double-blind study. Pain Pract 2021; 22:57-65. [PMID: 34145727 DOI: 10.1111/papr.13050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Mohamed F Mostafa
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Osama Ali Ibraheim
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed K Ibrahim
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Reham A E Ibrahim
- Unit of Phoniatric, Otorhinolaryngology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ragaa Herdan
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt
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The Effect of Pregabalin on the Prevention of Succinylcholine-Induced Fasciculation and Myalgia. J Perianesth Nurs 2020; 35:255-259. [PMID: 31992495 DOI: 10.1016/j.jopan.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE This study evaluates the effect of pregabalin on fasciculation and myalgia after using succinylcholine. DESIGN This randomized double-blind prospective study was conducted among 100 patients aged 20 to 60 years old. METHODS Pregabalin (300 mg) and placebo (in capsule form) were placed in similar containers. The results were analyzed by SPSS 23 software, and statistical analysis consisted of χ2 test and t test, and a P value less than .05 was considered significant. FINDINGS The mean pain score in the group receiving pregabalin was lower than the placebo group. According to the χ2 test, there was a significant difference between the two groups in the frequency of fasciculation (P = .003). Mean fasciculation severity in the pregabalin group was lower than placebo group. According to t test, there was a significant difference in the mean fasciculation severity between the two groups (P = .002). CONCLUSIONS This study showed that 300 mg of pregabalin was effective in reducing postoperative fasciculation and myalgia in patients treated with succinylcholine.
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Nasseri K, Arvien S. Effects of low-dose ketamine on succinylcholine-induced postoperative myalgia in outpatient surgeries: a randomized, double-blind study. J Pain Res 2016; 9:503-8. [PMID: 27462175 PMCID: PMC4940009 DOI: 10.2147/jpr.s106576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Despite the many complications of succinylcholine, it is still widely used as a superior muscle relaxant for rapid sequence induction. One of these complications is postoperative myalgia (POM). The aim of this study was to investigate the prophylactic effect of low-dose ketamine on the incidence and severity of POM. Materials and methods In this double-blind clinical study, a total of 148 patients scheduled for general anesthesia were randomly divided into two equal groups. Initially, in Group K, 0.5 mg/kg of ketamine was injected intravenously, whereas in Group N, the same volume (5 mL) of normal saline was injected. Thereafter, anesthesia was induced in all patients, by injecting 1.5 mg/kg of fentanyl and 2 mg/kg of propofol intravenously. Following the loss of eyelid reflex, 1.5 mg/kg of succinylcholine was injected intravenously as a muscle relaxant and then the patients were intubated. POM was defined as a pain with no surgical interferences, and its intensity was graded based on a four-point scale. The incidence and severity of myalgia were assessed by a blinded observer 24 hours after surgery. Results In terms of demographic data, the results of this study showed that there is no significant difference between patients in both groups (P>0.05). Overall, the incidence of POM in Group K was significantly less, when compared with Group N (P<0.05), but both groups were comparable based on the grade 2 of POM. After the induction of anesthesia, the systolic and diastolic blood pressure values were found to reduce in both groups (P<0.05). However, the changes were somehow similar, and repeated measures of variance analysis showed no significant difference in the two study groups (P>0.05). Conclusion The addition of 0.5 mg/kg of ketamine to propofol for the induction of anesthesia can be effective in reducing the incidence of low-grade POM.
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Affiliation(s)
- Karim Nasseri
- Department of Anesthesia and Intensive Care, Social Determinants of Health Research Center
| | - Sanaz Arvien
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ömür D, Kiraz HA, Şahin H, Toman H, Uyan B, Ekin S, Hancı V. Use of Succinylcholine by Anaesthetists in Turkey: A National Survey. Turk J Anaesthesiol Reanim 2016; 43:323-31. [PMID: 27366522 DOI: 10.5152/tjar.2015.03708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 02/19/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Although succinylcholine (SCh) has side effects, it is among the most commonly used muscle relaxants for rapid induction because of the faster onset of its effects and short effect duration. However, there is no information regarding the frequency of use of SCh by anaesthetists in Turkey. This study aims to investigate the use of SCh by anaesthetists working in Turkey. METHODS A web-based survey form was sent by e-mail to anaesthetists working in Turkey. The form comprised a total of 24 questions. RESULTS E-mails were sent to a total of 1882 addresses at two separate times. E-mail replies were received from 433 (23%) anaesthetists. Based on those who responded to the survey, 54.27% anaesthetists routinely used SCh for adult elective cases, 29.33% for paediatric elective cases and 74.13% for emergency cases. In adult elective cases, SCh was most frequently chosen for caesarean section (20.5%), and in paediatric elective and emergency cases, SCh was chosen most frequently because difficult intubation was expected (31.3 and 21.4%, respectively). CONCLUSION Our study reveals that SCh is still widely used by anaesthetists in Turkey. Majority of physicians who participated our survey were aware of the side effects; however, they reported using SCh in certain special situations. It is evident that creation of a standard care guide for departments is essential. The first stage of creating a standard care guide is to analyse and document the current application. With this aim, more wide-ranging advanced studies should be completed.
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Affiliation(s)
- Dilek Ömür
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hasan Ali Kiraz
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Hasan Şahin
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Hüseyin Toman
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Berna Uyan
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Serpil Ekin
- Department of Anaesthesiology and Reanimation, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Turkey
| | - Volkan Hancı
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Srivastava VK, Agrawal S, Nimbhorkar VK, Mishra A, Sharma S, Panda PK. Prophylactic use of pregabalin for prevention of succinylcholine-induced fasciculation and myalgia: a randomized, double-blinded, placebo-controlled study. Braz J Anesthesiol 2016; 66:165-70. [PMID: 26952225 DOI: 10.1016/j.bjane.2014.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/07/2014] [Indexed: 11/27/2022] Open
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 150mg of pregabalin orally 1h prior to induction of anesthesia with sips of water and patients in Group C (control group) received placebo. Anesthesia was induced with fentanyl 1.5mcg/kg, propofol 1.5-2.0mg/kg followed by succinylcholine 1.5mg/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 24h 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 150mg prevents succinylcholine-induced fasciculations and myalgia and also decreases the fentanyl consumption in elective sine surgery.
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Affiliation(s)
| | - Sanjay Agrawal
- Himalayan Institute of Medical Sciences, Dehradun, India
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Uso profilático de pregabalina para prevenção de mialgia e fasciculação induzidas por succinilcolina: estudo randômico, duplo‐cego e controlado por placebo. Braz J Anesthesiol 2016; 66:165-70. [DOI: 10.1016/j.bjan.2016.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022] Open
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Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia 2015; 70:1186-204. [DOI: 10.1111/anae.13179] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | - J. N. Lund
- Department of Surgery; University of Nottingham; Derby UK
| | - J. P. Williams
- Department of Anaesthesia; University of Nottingham; Derby UK
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Rayhill ML, Perloff MD. Gabapentin use in the prevention of succinylcholine-induced fasciculation and myalgia. J Postgrad Med 2012; 58:1-2. [PMID: 22387640 DOI: 10.4103/0022-3859.93244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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