Non-depolarizing Neuromuscular Blockers for Prevention of Succinylcholine-induced Myalgia: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIXin , XUANYan ,  WANGJiang , ZHENGHong , ZHANGYong-qiang

Department of Anesthesiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

WANGJiang, Email: 710985359@qq.com

Keywords：

Succinylcholine; Myalgia; Non-depolarizing neuromuscular blocker; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150012

Video：

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Objective To systematically review the effectiveness of non-depolarizing neuromuscular blockers for the prevention of succinylcholine-induced myalgia in clinical practice. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 2, 2014), WanFang Data, CBM and CNKI were searched to collect the randomized controlled trails (RCTs) about non-depolarizing neuromuscular blockers for the prevention of succinylcholine-induced myalgia from inception to March 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. Results A total of 11 RCTs involving 666 patients were included. The results of meta-analysis showed that:the pre-treatment of non-depolarizing neuromuscular blockers prevented succinylcholine-induced myalgia at 24 h after surgery (RR=0.46, 95%CI 0.39 to 0.55, P<0.000 01); however, the effectiveness of non-depolarizing neuromuscular blockers for prevention of succinylcholine-induced myalgia at 48 h after surgery was still unclear. Conclusion Current studies suggests that both rocuronium and atracurium are effective for the prevention of succinylcholine-induced myalgia. However, due to limited quantity and quality of the included studies, more high-quality studies are needed to verify the abovementioned conclusion.

Citation： LIXin, XUANYan, WANGJiang, ZHENGHong, ZHANGYong-qiang. Non-depolarizing Neuromuscular Blockers for Prevention of Succinylcholine-induced Myalgia: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(1): 62-68. doi: 10.7507/1672-2531.20150012 Copy

1.	Bourne JG, Collier HO, Somers GF. Succinylcholine (succinoylcholine), muscle-relaxant of short action. Lancet, 1952, 1(6721):1225-1229.
2.	Mencke T, Schreiber JU, Becker C, et al. Pretreatment before succinylcholine for outpatient anesthesia? Anesth Analg, 2002, 94(3):573-576.
3.	Pace NL. Prevention of succinylcholine myalgias:a meta-analysis. Anesth Analg, 1990,70(5):477-483.
4.	Churchill-Davidson HC. Suxamethonium (succinylcholine) chloride and muscle pain. Br J Anesth, 1954, 1(4853):74-75.
5.	Marr A, Sosis M:Effectiveness of atracurium in preventing succinylcholine myalgia. AANA J, 1989, 57(2):128-130.
6.	庄心良, 曾因明, 陈伯銮. 现代麻醉学(上册). 北京:人民卫生出版社, 2003:792-793.
7.	White DC. Observations on the prevention of muscle pains after suxamethonium. Br J Anesth, 1962, 34(5):332-335.
8.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochrane-handbook.org.
9.	Abbas N, Tariq S, Khan AW, et al. To assess the effects of Rocuronium pretreatment on Succinylcholine induced Fasciculations and postoperative Myalgias. J Pak Med Assoc, 2009, 59(5):847-850.
10.	Findlay GP, Spittal MJ. Rocuronium pretreatment reduces suxamethonium-induced myalgia:comparison with vecuronium. Br J Anaesth, 1996, 76(4):526-529.
11.	Houghton IT, Aun CS, Gin T, et al. Suxamethonium myalgia:An ethnic comparison with and without pancuronium pretreatment. Anaesthesia, 1993, 48(5):377-381.
12.	Joshi GP, Hailey A, Cross S, et al. Effects of pretreatment with cisatracurium, rocuronium, and tubocurarine on succinylcholine-induced fasciculations and myalgia:a comparison with placebo. J Clin Anesth, 1999, 11(8):641-645.
13.	Kim JH, Cho H, Lee HW, et al. Comparison of rocuronium and vecuronium pretreatment for prevention of fasciculations, myalgia and biochemical changes following succinylcholine administration. Acta Anaesthesiol Sin, 1999, 37(4):173-178.
14.	Manchikanti L, Grow JB, Colliver JA, et al. Atracurium pretreatment for succinylcholine-induced fasciculations and postoperative myalgia. Anesth Analg, 1985, 64(10):1010-1014.
15.	Martin R, Carrier J, Pirlet M, et al. Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia. Can J Anaesth, 1998, 45(6):521-525.
16.	McLoughlin C, Elliott P, McCarthy G, et al. Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens. Anaesthesia, 1992, 47(3):202-206.
17.	Melnick B, Chalasani J, Lim NT, et al. Decreasing post-succinylcholine myalgia in outpatients. Can J Anaesth, 1987, 34(3):238-241.
18.	Mingus ML, Herlich A, Eisenkraft JB. Attenuation of suxamethonium myalgias. Anaesthesia, 1991, 46(7):589-589.
19.	Raman SK, San WM. Fasciculations, myalgia and biochemical changes following succinylcholine with atracurium and lidocaine pretreatment. Can J Anaesth, 1997, 44(5):498-502.
20.	Sosis M, Broad T, Larijani GE, et al. Comparison of atracurium and d-tubocurarine for prevention of succinylcholine myalgia. Anesth Analg, 1987, 66(7):657-659.
21.	Theroux MC, Rose JB, Iyengar S, et al. Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children:A randomized, controlled study. J Clin Anesth, 2001, 13(4):287-292.
22.	Newnam PT, Loudon JM. Muscle pain following administration of suxamethonium:The aetiological role of muscular fitness. Br J Anaesth, 1966, 38(7):533-540.
23.	Suarez-Kurtz G, Eastwood AB. Release of sarcoplasmic enzymes from frog skeletal muscle. Am J Physiol, 1981, 241(3):98-105.
24.	McLoughlin C, Nesbitt GA, Howe JP. Suxamethonium induced myalgia and the effect of preoperative administration of oral aspirin. Anaesthesia, 1988, 43(7):565-567.
25.	McLoughlin C, Leslie K, Caldwell JE. Influence of dose on suxamethonium induced muscle damage. Br J Anaesth, 1994, 73(2):194-198.
26.	Jackson MJ, Jones DA, Edwards RH. Experimental skeletal muscle damage:The nature of calcium activated degenerative processes. Eur J Clin Invest, 1984, 14(5):369-374.
27.	Jackson MJ, Wagenmakers AJ, Edwards RH. Effect of inhibitors of arachidonic acid metabolism on efflux of intracellular enzymes from skeletal muscle following experimental damage. Biochem J, 1987, 241(2):403-407.
28.	Duncan CJ. The role of phospholipase A2 in calcium-induced damage in cardiac and skeletal muscle. Cell Tissue Res, 1988, 253(2):457-462.
29.	Stoelting RK, Peterson C. Adverse effects of increased succinylcholine dose following d-tubocurarine pretreatment. Anesth Analg, 1975, 54(3):282-288.
30.	康德英, 洪旗. Meta 分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1):45-49.

1. Bourne JG, Collier HO, Somers GF. Succinylcholine (succinoylcholine), muscle-relaxant of short action. Lancet, 1952, 1(6721):1225-1229.
2. Mencke T, Schreiber JU, Becker C, et al. Pretreatment before succinylcholine for outpatient anesthesia? Anesth Analg, 2002, 94(3):573-576.
3. Pace NL. Prevention of succinylcholine myalgias:a meta-analysis. Anesth Analg, 1990,70(5):477-483.
4. Churchill-Davidson HC. Suxamethonium (succinylcholine) chloride and muscle pain. Br J Anesth, 1954, 1(4853):74-75.
5. Marr A, Sosis M:Effectiveness of atracurium in preventing succinylcholine myalgia. AANA J, 1989, 57(2):128-130.
6. 庄心良, 曾因明, 陈伯銮. 现代麻醉学(上册). 北京:人民卫生出版社, 2003:792-793.
7. White DC. Observations on the prevention of muscle pains after suxamethonium. Br J Anesth, 1962, 34(5):332-335.
8. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration. 2011. Available at:www.cochrane-handbook.org.
9. Abbas N, Tariq S, Khan AW, et al. To assess the effects of Rocuronium pretreatment on Succinylcholine induced Fasciculations and postoperative Myalgias. J Pak Med Assoc, 2009, 59(5):847-850.
10. Findlay GP, Spittal MJ. Rocuronium pretreatment reduces suxamethonium-induced myalgia:comparison with vecuronium. Br J Anaesth, 1996, 76(4):526-529.
11. Houghton IT, Aun CS, Gin T, et al. Suxamethonium myalgia:An ethnic comparison with and without pancuronium pretreatment. Anaesthesia, 1993, 48(5):377-381.
12. Joshi GP, Hailey A, Cross S, et al. Effects of pretreatment with cisatracurium, rocuronium, and tubocurarine on succinylcholine-induced fasciculations and myalgia:a comparison with placebo. J Clin Anesth, 1999, 11(8):641-645.
13. Kim JH, Cho H, Lee HW, et al. Comparison of rocuronium and vecuronium pretreatment for prevention of fasciculations, myalgia and biochemical changes following succinylcholine administration. Acta Anaesthesiol Sin, 1999, 37(4):173-178.
14. Manchikanti L, Grow JB, Colliver JA, et al. Atracurium pretreatment for succinylcholine-induced fasciculations and postoperative myalgia. Anesth Analg, 1985, 64(10):1010-1014.
15. Martin R, Carrier J, Pirlet M, et al. Rocuronium is the best non-depolarizing relaxant to prevent succinylcholine fasciculations and myalgia. Can J Anaesth, 1998, 45(6):521-525.
16. McLoughlin C, Elliott P, McCarthy G, et al. Muscle pains and biochemical changes following suxamethonium administration after six pretreatment regimens. Anaesthesia, 1992, 47(3):202-206.
17. Melnick B, Chalasani J, Lim NT, et al. Decreasing post-succinylcholine myalgia in outpatients. Can J Anaesth, 1987, 34(3):238-241.
18. Mingus ML, Herlich A, Eisenkraft JB. Attenuation of suxamethonium myalgias. Anaesthesia, 1991, 46(7):589-589.
19. Raman SK, San WM. Fasciculations, myalgia and biochemical changes following succinylcholine with atracurium and lidocaine pretreatment. Can J Anaesth, 1997, 44(5):498-502.
20. Sosis M, Broad T, Larijani GE, et al. Comparison of atracurium and d-tubocurarine for prevention of succinylcholine myalgia. Anesth Analg, 1987, 66(7):657-659.
21. Theroux MC, Rose JB, Iyengar S, et al. Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children:A randomized, controlled study. J Clin Anesth, 2001, 13(4):287-292.
22. Newnam PT, Loudon JM. Muscle pain following administration of suxamethonium:The aetiological role of muscular fitness. Br J Anaesth, 1966, 38(7):533-540.
23. Suarez-Kurtz G, Eastwood AB. Release of sarcoplasmic enzymes from frog skeletal muscle. Am J Physiol, 1981, 241(3):98-105.
24. McLoughlin C, Nesbitt GA, Howe JP. Suxamethonium induced myalgia and the effect of preoperative administration of oral aspirin. Anaesthesia, 1988, 43(7):565-567.
25. McLoughlin C, Leslie K, Caldwell JE. Influence of dose on suxamethonium induced muscle damage. Br J Anaesth, 1994, 73(2):194-198.
26. Jackson MJ, Jones DA, Edwards RH. Experimental skeletal muscle damage:The nature of calcium activated degenerative processes. Eur J Clin Invest, 1984, 14(5):369-374.
27. Jackson MJ, Wagenmakers AJ, Edwards RH. Effect of inhibitors of arachidonic acid metabolism on efflux of intracellular enzymes from skeletal muscle following experimental damage. Biochem J, 1987, 241(2):403-407.
28. Duncan CJ. The role of phospholipase A2 in calcium-induced damage in cardiac and skeletal muscle. Cell Tissue Res, 1988, 253(2):457-462.
29. Stoelting RK, Peterson C. Adverse effects of increased succinylcholine dose following d-tubocurarine pretreatment. Anesth Analg, 1975, 54(3):282-288.
30. 康德英, 洪旗. Meta 分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1):45-49.

Chinese Journal of Evidence-Based Medicine

Non-depolarizing Neuromuscular Blockers for Prevention of Succinylcholine-induced Myalgia: A Meta-analysis

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