Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia

Can J Anaesth. 1998 Jun;45(6):521-5. doi: 10.1007/BF03012701.

Abstract

Purpose: To determine which non-depolarizing relaxant among d-tubocurarine, vecuronium, atracurium, mivacurium and rocuronium prevented muscular fasciculations and myalgia following succinylcholine.

Methods: In this double blind randomized study, 120 female patients scheduled for laparoscopic procedures were studied. They were divided into six groups of 20 according to the non-depolarizing pretreatment used: NaCl 0.9% (control), 0.05 mg.kg-1 d-tubocurarine, 0.01 mg.kg-1 vecuronium, 0.05 mg.kg-1 atracurium, 0.02 mg.kg-1 mivacurium and 0.06 mg.kg-1 rocuronium. Four minutes after the pretreatment, 1.5 mg.kg-1 succinylcholine was injected. Side effects of the pretreatment, the presence and magnitude of fasciculations, the ease of tracheal intubation, myalgia 1, 24 and 48 hr after surgery were observed. A Puritan Bennett Datex 221 NMT Relaxograph monitor was used to evaluate the neuromuscular block.

Results: Muscle fasciculations were observed in 19 of the 20 patients in the control group and in 3 of the 20 patients in the rocuronium group, the best of the pretreatments in that aspect. Four patients in the mivacurium group were unable to sustain more than four seconds head-lift after pretreatment (P < 0.05). Tracheal intubation conditions were better and the onset of block was faster and longer after succinylcholine in the control group (P < 0.05). Myalgias were present in 71% of the patients 24 hr postoperatively and the frequency was not different among the groups.

Conclusion: Among the pretreatments tested, 0.06 mg.kg-1 rocuronium was the best to prevent muscular fasciculations following succinylcholine injection. In the population studied, pretreatment did not prevent postoperative myalgia. Succinylcholine 1.5 mg.kg-1 was more effective without a non-depolarizing pretreatment.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Androstanols / administration & dosage*
  • Atracurium / administration & dosage
  • Double-Blind Method
  • Fasciculation / prevention & control*
  • Female
  • Follow-Up Studies
  • Humans
  • Intubation, Intratracheal
  • Isoquinolines / administration & dosage
  • Laparoscopy
  • Mivacurium
  • Muscle, Skeletal / drug effects*
  • Neuromuscular Blockade*
  • Neuromuscular Depolarizing Agents / adverse effects*
  • Neuromuscular Nondepolarizing Agents / administration & dosage*
  • Pain / prevention & control*
  • Rocuronium
  • Succinylcholine / adverse effects*
  • Time Factors
  • Tubocurarine / administration & dosage
  • Vecuronium Bromide / administration & dosage

Substances

  • Androstanols
  • Isoquinolines
  • Neuromuscular Depolarizing Agents
  • Neuromuscular Nondepolarizing Agents
  • Atracurium
  • Mivacurium
  • Vecuronium Bromide
  • Succinylcholine
  • Tubocurarine
  • Rocuronium