Succinylcholine Myalgias
Background
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Succinylcholine (sux) is a depolarizing neuromuscular agent with rapid onset and short duration of action
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Post-op myalgias are one of the adverse effects of using sux - incidence varies from 50-90%
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Myalgias vary in severity and duration - sometimes lasting up to several days post-op
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Described as similar to muscle soreness after intense physical exercise
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They may be severe and interfere with return to normal ADLs
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Pathophysiology not yet clear
Considerations
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Typically self-limited but may interfere with rapid return to normal function
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Protective factors:
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Children
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Age > 50
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Female
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Pregnancy
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Better muscular fitness
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Risk factors:
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Minor procedures
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Early ambulation
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Prevention
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Avoid use of succinycholine
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Use a higher-dose of sux (1.5 mg/kg causes less myalgias than 1 mg/kg)
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Pre-treat with:
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NSAIDs (75mg diclofenac 20 min pre-op)
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Lidocaine (1.5 mg/kg just before sux)
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Low-dose non-depolarizing neuromuscular blocking (0.04 mg/kg of rocuronium 2 mins before sux)
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Management
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Post-operative muscle stretching exercises
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High-dose Vitamin C
References
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Schreiber JU, Lysakowski C, Fuchs-Buder T, Tramèr MR. Prevention of succinylcholine-induced fasciculation and myalgia: a meta-analysis of randomized trials. Anesthesiology. 2005 Oct;103(4):877-84. doi: 10.1097/00000542-200510000-00027. PMID: 16192781.