Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials.
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.
Schreiber
Jan-Uwe
JU
Department of Anesthesiology and Critical Care Medicine, University Hospital of the Saarland, Homburg, Germany. jan.schreiber@uniklinik-saarland.de
Lysakowski
Christopher
C
Fuchs-Buder
Thomas
T
Tramèr
Martin R
MR
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005207:Fasciculation / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use; D009135:Muscular Diseases / Q000139:chemically induced / Q000517:prevention & control*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D013390:Succinylcholine / Q000009:adverse effects*; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D003473:Neuromuscular Nondepolarizing Agents; D008012:Lidocaine; D013390:Succinylcholine