Comparison of atracurium and "mini-dose" succinylcholine for preventing succinylcholine-induced muscle fasciculations: a randomized, double-blind, placebo-controlled study.
Several drugs have been used to prevent or attenuate succinylcholine- induced muscle fasciculations. There are possible advantages to succinylcholine pretreatment. We designed the present study to compare the effectiveness of atracurium versus "mini-dose" (5 mg) succinylcholine pretreatment for the prevention of muscle fasciculations.


METHODS
Under standard monitoring, 79 patients were randomly assigned to three groups after premedication: Group 1 (n = 26) received normal saline as a placebo, Group 2 (n = 27) received 0.03 mg/kg atracurium, and Group 3 (n = 26) received 5 mg succinylcholine. Thiopental (4 mg/kg) was administered intravenously 90 seconds after pretreatment, followed by intravenous administration of 1.5 mg/kg succinylcholine. An anesthesiologist graded fasciculations based on a four-point scale, from 0 (none) to 3 (severe). All patients were evaluated on the first postoperative day for the presence of postoperative myalgia (POM), the severity of which was graded on a four-point scale, from 0 = no myalgia to 3 = generalized, severe discomfort.


RESULTS
There were no statistical differences among the three groups with respect to sex, weight or age. In Group 1, 3.8% of the patients showed no fasciculations, while 30.8% had mild, 53.8% had moderate and 11.5% had vigorous fasciculations. In Group 2, fasciculations were absent in 74.1% of the patients, while 25.9% of the patients had mild fasciculations. In Group 3, 23.1% patients had no fasciculations, while 42.3%, 30.8% and 3.8% of the patients showed mild, moderate and vigorous fasciculations, respectively, with succinylcholine pretreatment. There was no difference in the presence or severity of myalgia between Groups 1 and 3. Furthermore, the presence of fasciculations was not correlated with POM in Groups 1 and 3, but a significant correlation was found in Group 2.


CONCLUSIONS
Our results showed that the incidence and severity of fasciculations were significantly decreased by atracurium pretreatment but not by pretreatment with succinylcholine or placebo (p<0.0001 and p=0.0003 respectively). However, atracurium did not exert significant effects on POM.
Fatemeh
Hajimohamadi
H
Department of Anesthesiology, Amir Alam Hospital, Medical Sciences/University of Tehran, Iran.
Mojgan
Rahimi
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001279:Atracurium / Q000494:pharmacology*; D004311:Double-Blind Method; D005207:Fasciculation / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects* / Q000494:pharmacology*; D013390:Succinylcholine / Q000009:adverse effects*
D009467:Neuromuscular Depolarizing Agents; D001279:Atracurium; D013390:Succinylcholine