title: Effects of pretreatment with cisatracurium, rocuronium, and d-tubocurarine on succinylcholine-induced fasciculations and myalgia: a comparison with placebo.
abstract: OBJECTIVE
  To evaluate the efficacy of cisatracurium, rocuronium, and d-tubocurarine in preventing succinylcholine-induced fasciculations and postoperative myalgia in patients undergoing ambulatory surgery.
  
  
  METHODS
  Randomized, prospective, placebo-controlled trial
  
  
  METHODS
  Teaching hospital.
  
  
  METHODS
  80 ASA physical status I and II patients scheduled for elective ambulatory surgery with general anesthesia.
  
  
  METHODS
  A standardized balanced anesthetic technique was used for all patients.
  
  
  RESULTS
  Patients were randomized to receive cisatracurium 0.01 mg/kg, rocuronium 0.06 mg/kg, d-tubocurarine 0.05 mg/kg, or saline, 3 minutes prior to intravenous (i.v.) succinylcholine 1.5 mg/kg. The intensity of fasciculations and intubating conditions were assessed using a four-point rating scale. In addition, the severity of myalgia was assessed using a four-point rating scale in the postanesthesia care unit and at 24 hours postoperatively. No patient complained of any side effects after the administration of the study drug. Fasciculations were observed less frequently (p < 0.05) in the d-tubocurarine and rocuronium groups compared with the placebo and cisatracurium groups. However, there was no difference between the d-tubocurarine group and the rocuronium group (21% vs. 10%, respectively). Although fasciculations occurred less frequently in the cisatracurium group than in the placebo group (59% vs. 85%, respectively), this difference did not reach statistical significance. There was no difference among the four groups in the intubating conditions or the incidence of postoperative myalgia.
  
  
  CONCLUSIONS
  Pretreatment with rocuronium and d-tubocurarine was superior to cisatracurium in preventing succinylcholine-induced fasciculations. However, pretreatment did not have any effect on the incidence of myalgia after ambulatory surgery.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA. girish.joshi@email.swmed.edu
authors.forename: G P
authors.initials: GP
authors.lastname: Joshi
authors.forename: A
authors.initials: A
authors.lastname: Hailey
authors.forename: S
authors.initials: S
authors.lastname: Cross
authors.forename: G
authors.initials: G
authors.lastname: Thompson-Bell
authors.forename: C C
authors.initials: CC
authors.lastname: Whitten
mesh_terms: D000328:Adult; D000368:Aged; D000732:Androstanols / Q000494:pharmacology*; D001279:Atracurium / Q000031:analogs & derivatives* / Q000494:pharmacology; D005207:Fasciculation / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced*; D009466:Neuromuscular Blocking Agents / Q000494:pharmacology*; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced*; D011446:Prospective Studies; D000077123:Rocuronium; D013390:Succinylcholine / Q000009:adverse effects*; D014403:Tubocurarine / Q000494:pharmacology*
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D001279:Atracurium; D013390:Succinylcholine; C101584:cisatracurium; D014403:Tubocurarine; D000077123:Rocuronium