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Succinylcholine Myalgias


  • Succinylcholine (sux) is a depolarizing neuromuscular agent with rapid onset and short duration of action

  • Post-op myalgias are one of the adverse effects of using sux - incidence varies from 50-90%

  • Myalgias vary in severity and duration - sometimes lasting up to several days post-op

  • Described as similar to muscle soreness after intense physical exercise

  • They may be severe and interfere with return to normal ADLs

  • Pathophysiology not yet clear


  • Typically self-limited but may interfere with rapid return to normal function

  • Protective factors:

    • Children

    • Age > 50

    • Female

    • Pregnancy

    • Better muscular fitness

  • Risk factors:

    • Minor procedures

    • Early ambulation


  • Avoid use of succinycholine

  • Use a higher-dose of sux (1.5 mg/kg causes less myalgias than 1 mg/kg)

  • Pre-treat with:

    • NSAIDs (75mg diclofenac 20 min pre-op)

    • Lidocaine (1.5 mg/kg just before sux)

    • Low-dose non-depolarizing neuromuscular blocking (0.04 mg/kg of rocuronium 2 mins before sux) 



  • Post-operative muscle stretching exercises 

  • High-dose Vitamin C


  • 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.

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