Results 21 to 30 of 37

Thread: To defasiculate or not for prevention of post op myalgias

Threaded View

Previous Post Previous Post   Next Post Next Post
  1. #1
    Join Date
    Jul 2006
    Location
    Glendale, Arizona, United States
    Posts
    18,746
    Blog Entries
    107
    Downloads
    44
    Uploads
    3


    1 out of 1 members found this post helpful. Did you find this post helpful? Yes | No

    Question To defasiculate or not for prevention of post op myalgias

    Here are 3 pretty convincing articles. Whats your take?


    Article #1:

    Entire article can be read HERE

    Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials.
    Schreiber JU, Lysakowski C, Fuchs-Buder T, Tramèr MR.
    Source
    Department of Anesthesiology and Critical Care Medicine, University Hospital of the Saarland, Homburg, Germany. jan.schreiber@uniklinik-saarland.de
    Abstract


    Fifty-two randomized trials (5,318 patients) were included in this meta-analysis. In controls, the incidence of fasciculation was 95%, and the incidence of myalgia at 24 h was 50%. Nondepolarizing muscle relaxants, lidocaine, or magnesium prevented fasciculation (number needed to treat, 1.2-2.5). Best prevention of myalgia was with nonsteroidal antiinflammatory drugs (number needed to treat, 2.5) and with rocuronium or lidocaine (number needed to treat, 3). There was a dose-dependent risk of blurred vision, diplopia, voice disorders, and difficulty in breathing and swallowing (number needed to harm, < 3.5) with muscle relaxants. There was evidence of less myalgia with 1.5 mg/kg succinylcholine (compared with 1 mg/kg). Opioids had no impact. Succinylcholine-induced fasciculation may best be prevented with muscle relaxants, lidocaine, or magnesium. Myalgia may best be prevented with muscle relaxants, lidocaine, or nonsteroidal antiinflammatory drugs. The risk of potentially serious adverse events with muscle relaxants is not negligible. Data that allow for a risk-benefit assessment are lacking for other drugs.

    Article #2

    Whole article HERE

    Pretreatment Before Succinylcholine for Outpatient Anesthesia?

    Abstract


    IMPLICATIONS: This study demonstrated that pretreatment of succinylcholine with rocuronium failed to decrease the incidence or the severity of postoperative myalgia. However, in most patients, pretreatment was associated with muscle weakness before loss of consciousness. Thus, there is no convincing evidence supporting routine pretreatment with succinylcholine.


    Succinylcholine is a popular muscle relaxant for ambulatory anesthesia (1). Unfortunately, postoperative myalgia (POM) may frequently occur after the use of succinylcholine (2–7) and this myalgia may be particularly troublesome in outpatients (3,5,6). Although pretreatment with succinylcholine with nondepolarizing myorelaxants seems to be effective in decreasing muscle fasciculation, its effectiveness in reducing POM is controversial (5,6). Moreover, pretreatment may produce muscle weakness preceding loss of consciousness (8). Interestingly, increasing evidence suggests that POM is multifactorial in its origin, with succinylcholine being only one contributing factor (3,5,9,10). Therefore, it is of clinical relevance in the context of ambulatory anesthesia to quantify the specific contribution of succinylcholine on POM, thus allowing clinicians to decide whether strategies to prevent succinylcholine-induced myalgia pretreatment are worth their side effects. To this end, this study was designed to compare the incidence and severity of POM after succinylcholine—with and without pretreatment—with those observed in a control group not receiving succinylcholine but using a nondepolarizing myorelaxant. Moreover, the side effects of pretreatment were also systematically assessed.
    Last edited by ADMIN; 12-29-2011 at 01:28 PM.
    Mike

    Success in life is the result of good judgment. Good judgment is usually the result of experience. Experience is usually the result of bad judgment.

    ~Anthony Robbins


    All statements made by me are my own opinion and not that of any organization, workplace, association or group I may be apart of.

Similar Threads

  1. Replies: 2
    Last Post: 06-17-2015, 05:06 PM
  2. Defasiculate with Sux?
    By RAYMAN in forum Anesthesia Clinical Cases, Questions & Pearls
    Replies: 43
    Last Post: 07-23-2011, 06:38 AM
  3. Guidelines for prevention of endocarditis
    By FORANE in forum Clinical Case Studies & Clinical Questions
    Replies: 1
    Last Post: 03-03-2010, 04:05 PM
  4. Prevention of Perioperative Cardiac Morbidity part 1-8 Video
    By ADMIN in forum Anesthesia Pharmacology, Procedures & Equipment
    Replies: 7
    Last Post: 01-21-2007, 06:33 AM
  5. Defasiculate or not?
    By athomas91 in forum Anesthesia Clinical Cases, Questions & Pearls
    Replies: 13
    Last Post: 08-15-2006, 05:56 PM

Tags for this Thread

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •