Optimal precurarizing dose of rocuronium to decrease fasciculation and myalgia following succinylcholine administration

Abstract

Background: Succinylcholine commonly produces frequent adverse effects, including muscle fasciculation and myalgia. The current study identified the optimal dose of rocuronium to prevent succinylcholine-induced fasciculation and myalgia and evaluated the influence of rocuronium on the speed of onset produced by succinylcholine.

Methods: This randomized, double-blinded study was conducted in 100 patients randomly allocated into five groups of 20 patients each. Patients were randomized to receive 0.02, 0.03, 0.04, 0.05 and 0.06 mg/kg rocuronium as a precurarizing dose. Neuromuscular monitoring after each precurarizing dose was recorded from the adductor pollicis muscle using acceleromyography with train-of-four stimulation of the ulnar nerve. All patients received succinylcholine 1.5 mg/kg at 2 minutes after the precurarization, and were assessed the incidence and severity of fasciculations, while myalgia was assessed at 24 hours after surgery.

Results: The incidence and severity of visible muscle fasciculation was significantly less with increasing the amount of precurarizing dose of rocuronium (P < 0.001). Those of myalgia tend to decrease according to increasing the amount of precurarizing dose of rocuronium, but there was no significance (P = 0.072). The onset time of succinylcholine was significantly longer with increasing the amount of precurarizing dose of rocuronium (P < 0.001).

Conclusions: Precurarization with 0.04 mg/kg rocuronium was the optimal dose considering the reduction in the incidence and severity of fasciculation and myalgia with acceptable onset time, and the safe and effective precurarization.

Keywords: Fasciculation; Myalgia; Neuromuscular blockade; Precurarization; Rocuronium; Succinylcholine.

Fig. 1

Flow chart of the study.

Fig. 2

Onset time (A) and fasciculation rate (B) after succinylcholine 0.15 mg/kg following precurarization with rocuronium 0.02 mg/kg (Group 0.02), rocuronium 0.03 mg/kg (Group 0.03), rocuronium 0.04 mg/kg (Group 0.04), rocuronium 0.05 mg/kg (Group 0.05) and rocuronium 0.06 mg/kg (Group 0.06), respectively. We used the scoring system for fasciculation described by Joshi et al. [9] 0 = none, 1 = mild, 2 = moderate, 3 = severe. ^*P < 0.05 versus Group 0.02, ^†P < 0.05 versus Group 0.03. ^‡P < 0.05 versus Group 0.04. (A) = solid circles with error bars, (B) = bar.