Anesthesia & Clinical Research
Open Access

Abstract

Preventive Strategies of Suxamethonium-Induced Fasciculation and Myalgia: A Review of Article and Guideline

Negesse Zurbachew Gobezie*, Nigussie Simeneh Endalew, Hailu Yimer Tawuye and Habtu Adane Aytolign

Introduction: Suxamethonium is an ultra-short-acting depolarizing muscle relaxant used for providing ideal intubating conditions during anesthesia. Despite having many advantages, suxamethonium commonly produces a number of undesirable effects. The majority of suxamethonium induced adverse effects are due to fasciculation of skeletal muscles during its administration. The aim of this review was to develop evidence based protocol for the prevention of suxamethonium induced muscle fasciculation and postoperative muscle pain.

Methods: After formulating the key questions and eligibility criteria for the articles to be included, advanced search strategy of electronic sources was conducted. Screening of literatures was conducted with proper appraisal checklist. This review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement. A total of 43 articles (three meta-analyses, two systematic reviews, thirty-seven RCTs and one cohort study) were included and reviewed.

Conclusion: The use of suxamethonium to facilitate tracheal intubation is followed by fasciculation and troublesome myalgia. The incidence of fasciculation and myalgia is higher in patients who undergo minor surgery, patients which ambulate early, outpatient surgeries, surgeries in lithotomy position, patients who are taking statin and using suxamethonium dose less than 1.5 mg/kg. Non-pharmacologically, slow repeated prolonged stretch exercise before induction of anesthesia and pharmacologically, pretreatment with a small dose of non-depolarizing muscle relaxants, pretreatment with lidocaine, diazepam, diclofenac, magnesium sulfate can reduce the incidence and severity of fasciculation and myalgia. In addition, using propofol as an induction agent and using suxamethonium at higher dose (>1.5 mg/kg) can reduce the incidence and severity of fasciculation and myalgia.

Published Date: 2025-07-22; Received Date: 2024-11-12