Abstract
Purpose
To determine the attenuation in the incidence of myalgia, fasciculations and changes in serum potassium and creatinine kinase concentrations when atracunum and lidocaine were used in combination and separately as pretreatment before succinylcholine.
Method
In a prospective, double blind randomized study, 80 ASA I patients 20–50 yr were assigned to one of four groups. Anaesthesia was induced with thiopentone and fentanyl. Group C received placebo pretreatment before 1.5 mg·kg−1 succinylcholine: Group A 0.05 mg·kg−1 atracunum three minutes before; Group L, 1.5 mg·kg−1 lidocaine 30 sec before; and group AL both atracurium and lidocaine. Serum potassium five minutes after succinylcholine. and creatinine kinase 24 hr after operation were measured and the increases from preinduction values were compared. Fasciculations and postoperative myalgia at 24 and 48 hr were recorded. Patients receivediv mependine orpo paracetamol for postoperative analgesia.
Results
The increase in serum potassium concentration (0.36 ± 0.23 mEq·l−1) was not attenuated by any regimen (P < 0.05). The incidence of fasciculations (P < 0.05) and the increase in creatinine kinase (P < 0.01) was less in the atracunum (40%; 20.93IU·I−1) and atracunum-lid ocaine (30%; 22.85IU·I−1) than in the lidocaine (85%; 45.01IU·I−1) and control (100%; 56.05 IU·I−1) groups. Postoperative myalgia on Days 1 and 2 was lowest (P < 0.05) in the atracurium-lidocaine group (5%; 0%) followed by the atracurium (35%; 25%) and lidocaine (30%; 35%) groups and highest in the control (75%; 65%).
Conclusion
Atracurium and lidocaine individually reduce postoperative myalgia, with further decrease occurring when used together.
Résumé
Objectif
Determiner le degré d’atténuation de la myalgie, des fasciculations, des variations de la kaliémie et des concentrations de la créatine kinase lorsque I’atracunum et la lidocaïne sont administrés conjointement ou séparément avant la succinylcholine.
Méthodes
Au cours d’une étude aléatoire prospective en double aveugle, 80 patients ASA I âgés de 20 à 50 ans ont été assignés à un de quatre groupes. L’anesthésie était induite au thiopentone et au fentanyl. Le groupe C a reçu un placebo avant I’administration de 1.5 mg·kgt-1 de succinylcholine; le groupe A, de I’atracurium 0,005 mg·kg−1 trois minutes avant; le groupe L, de la lidocaïne 1,5 mg·kg−1 30 sec avant et le groupe AL, à la fois I’atracunum et la lidocaïne. On a mesuré la kaliémie cinq minutes après la succinylcholine et la créatine kinase 24 h après I’opération et comparé les valeurs avec celles qui précédaient I’induction. On a noté les fasciculations et la myalgie préopératoire. L’analgésie postopératoire été réalisée avec de la mépéridineiv ou du paracétamolpo.
Résultats
Aucun des régimes n’a atténué l’augmentation de la kaliémie (90,36 ± 0,23 mEq.L-1, P < 0.05). Lincidence des fasciculations (P < 0,05) et I’augmentation de la créatine kinase étaient moins élevées dans les groupes atracunum (40%; 20,933 UI·L−1) et atracurium-lidocaïne (30%; 22,85 UI·L−1) que dans les groupes lidocaïne (85%; 45.01 UI·L−1) etcontrôle(100%; 56,05 UI·L−1). La myalgie postopératoire aux jours 1 et 2 était la moins fréquente (P < 0.05) dans le groupe atracunum-lidocaïne (5%; 0%) suivi des groupes atracunum (35%; 25%) et lidocaïne (30%; 35%) et la plus fréquente dans le groupe contrôle (75%; 65%).
Conclusion
L’atracurium et la lidocaïne diminuent individuellement la myalgie postopératoire mais sont plus efficace lorsqu’ils sont administrés conjointement.
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Raman, S.K., San, W.M. Fasciculations, myalgia and biochemical changes following succinylcholine with atracurium and lidocaine pretreatment. Can J Anaesth 44, 498–502 (1997). https://doi.org/10.1007/BF03011938
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DOI: https://doi.org/10.1007/BF03011938