A comparison of the differential effects of atracurium and/or lidocaine on succinylcholine-induced postoperative myalgia

It is well documented that the administration of succinylcholine (SCh), also known as suxamethonium, with general anesthesia causes muscle fasciculations, which may cause severe postoperative myalgia. However, such an association has not been well documented. Many authors have postulated that such pain is secondary to damage produced in the muscle during fasciculation. As a result, it is acceptable standard anesthetic practice to aim to prevent fasciculations when administering SCh during the administration of general anesthesia. Today, studies utilizing subtherapuetic doses of nondepolarizing neuromuscular blockade have shown the greatest promise in reducing postoperative myalgia secondary to the use of SCh. This study has examined and compared the efficacy of pretreatment with lidocaine, atracurium, and the combination of the two in relation to the incidence and severity of postoperative myalgia. As statistical significance was not expected with such a small pilot population, this study was designed to determine the feasibility of conducting a larger study. Additionally, trends within this population were further examined to determine clinical significance. This study was a prospective, double-blinded randomized clinical study utilizing 15 subjects who met inclusion criteria, and gave informed consent to participate in the study. Each patient was randomly assigned to one of three experimental groups that included lidocaine, atracurium, or a combination of the two medications. Each group followed the same study protocol. Participants were followed every 24 hours for three days. Data collected was based on a postoperative myalgia survey of 14 questions to ascertain myalgia from routine postoperative discomfort. The answers were then graded on a Likert scale (postoperative myalgia evaluation scale). In this way data collection not only included those having myalgia, but also took into account the intensity of postoperative myalgia. Data analysis compared the groups, looking for a statistical significant difference to determine whether one pretreatment medication was better than another in preventing postoperative myalgia. As expected, statistical significance was not found among the three pretreatment groups in relation to amount or intensity of postoperative_ myalgia. In other words, one pretreatment group did not show improved efficacy over another pretreatment group. However, several trends were identified, suggesting that each pretreatment medication may have advantages and disadvantages that may signify clinical significance, although not statistically significant. In conclusion, this study proved to be feasible, and identified many new factors such as physical health status, cigarette smoking, medication therapy prior to surgical intervention, surgical type, and surgical position that may contribute to the phenomena of postoperative myalgia. Therefore, further research in this area is warranted.