Comparison of the Effect of Pretreatment with Cisatracurium and Rocuronium on Succinylcholine Induced Fasciculation for Patients undergoing Surgery under General Anaesthesia: A Randomised Clinical Study

Abstract

Introduction: Succinylcholine is the best agent for providing ideal intubating condition. Muscle fasciculation is common after succinylcholine administration and causes postoperative myalgia. Pretreatment with non depolarising muscle relaxant decreases fasciculation and myalgia after succinylcholine administration. Aim: To compare the efficacy between cisatracurium and rocuronium in preventing succinylcholine induced fasciculation in patients undergoing general anaesthesia and determining association between fasciculation and myalgia after succinylcholine use. Materials and Methods: The present study was a hospital-based, randomised, double-blinded clinical study conducted from January 2020 to July 2020. The study included 64 patients of American Society of Anaesthesiologists (ASA) grade I and II undergoing surgery under general anaesthesia which were randomly allocated in two groups. Group 1 (N=32) received intravenous (i.v.) cisatracurium (0.01 mg/kg) and group 2 (N=32) received i.v. rocuronium (0.06 mg/kg) as precurarising agent, three minutes before i.v. succinylcholine (1.5 mg/kg) administration. Incidence and intensity of fasciculation after succinylcholine injection was observed using a 4 point scale. Haemodynamic parameters were compared by measuring Mean Arterial Pressure (MAP) and Heart Rate (HR) before and after intubation. Patients were followed-up in Postanesthesia Care Unit (PACU) on Postoperative Day 1 (POD1) for myalgia. Observations in two groups were analysed using standard statistical test. Results: Fasciculation was significantly lower in group 2 (mean 0.2187±0.4200) than group 1 (mean 1.125±0.833, p-value <0.001). A significant association was found between fasciculation after succinylcholine injection and postoperative myalgia (p-value=0.007). Group 2 had less incidence of myalgia than group 1. However, the difference was not statistically significant. Conclusion: Rocuronium was more efficacious than cisatracurium in preventing succinylcholine induced fasciculation and rocuronium was more effective in preventing succinylcholine-related postoperative myalgia.

Keywords

• non depolarising muscle relaxant
• precurarisation
• postoperative myalgia