The comparison of the combined effect of preoperative diclofenac and precurarisation with atracurium on succinylcholine induced myalgia in laparoscopic cholecystectomy: A double blinded randomised study

Abstract

Background and Aims: Succinylcholine is the only available depolarizing neuromuscular blocker which was widely used in induction of anaesthesia and it is the drug of choice for rapid-sequence induction of anaesthesia due to its rapid onset of effect and ultra-short duration of action owing to its rapid hydrolysis by acetyl-cholinesterase. Post-operative muscle pain (myalgia) and muscle stiffness are the most common side effects and observed most frequently on the first postoperative day in ambulatory surgery. The use of succinylcholine in induction of anaesthesia and intubation in routine cases has been discouraged because of such adverse effects, however because of its cost effectiveness and easy availability it is still used by some institutions routinely. The aim of this study was to study the efficacy of pre-operative diclofenac along with atracurium precurarization alleviating succinylcholine-induced myalgia. Material and methods: It is a double blind randomised comparative study carried our in a tertiary care hospital. Study sample was 60 and divided in two equal groups. All data entered in MS-Excel Sheet and Wilcoxon Signed Rank test was done for non-parametric data and one way ANOVA for parametric data. The normal distribution of study sample was tested by Shapiro Wilk test. Result and Conclusion: The incidence of fasciculation in the two groups were found to be significant with p < 0.00001. The results for incidence of myalgia in the two groups were as follows - p value at 24 hr was 0.00018 and at 48 hr was 0.0028 respectively. Creatine kinase levels at preoperative and 24 hr postoperative period were 49.47 ± 7.24 in group D , 53.30 ± 7.98 in group B and 87.38 ± 15.16 in group D , 188.41 ± 33.27 in group B respectively. Succinylcholine induced myalgia has a complex pathophysiology, however the pre-emptive use of diclofenac in combination with precurarization can alleviate the incidence and severity of succinylcholine induced myalgia. Therefore its use may be considered in routine cases for induction of anaesthesia for facilitating laryngoscopy and endotracheal intubation.