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    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.
    Department of Anesthesiology and Critical Care Medicine, University Hospital of the Saarland, Homburg, Germany.

    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?


    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 02:28 PM.

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