Muscle Pains Following the Use of Suxamethonium in Caesarean Section

Abstract

The incidence of severe muscle pain following Caesarean section in 130 patients in which suxamethonium was used was 15.7 per cent. Gallamine 20 mg prior to induction did not reduce the incidence of pain but resulted in technical difficulty which reduced the safety and effectiveness of the anaesthetic technique. It was concluded that the incidence of pains was not high enough to justify discarding the anaesthetic technique described. The use of non-depolarizing relaxants prior to induction as a method of reducing the incidence of pains following suxamethonium should be avoided in obstetric anaesthesia.

Diazepam Compared to Thiopentone as Induction Agent for Caesarean Sections

“…Thiopentone induction seemed to offer a protection against suxamethonium pains in contrast to its effect on recollections and dreams. Suxamethonium pains after caesarean section induced with thiopentone have been reported by BRYSON & ORMSTON (1962) to occur in 15.7% which is close to our findings with thiopentone. Suxamethonium pains after diazepam induction is reported to occur in 9% after a wide variety ofoperations (BAKER 1969).…”

Postoperative Muscle Pains and Suxamethonium

“…The postoperative muscle pains following these minor procedures are probably truly associated with suxamethonium, since they can be modified by a variety of techniques, including pretreatment with a small dose of non-depolarizing myoneural blocking drug before giving suxamethonium (Churchill-Davidson, 1954;Lamoreaux and Urbach, 1960;White, 1962;Dottori, L6f and Ygge, 1965;Glauber, 1966), lignocaine (Usubiaga et al, 1967;Haldia, Chatterji and Kackar, 1973), thiopentone (Burtles and Tunstall, 1961;Craig, 1964), vitamin C (Gupte and Savant, 1971) and diazepam (Verma, Chatterji and Mathur, 1978). The most commonly employed method, pretreatment with a non-depolarizing myoneural blocker, did not reduce the frequency of myalgia after operation in two wellcontrolled studies of patients undergoing major abdominal surgery (Bryson and Ormston, 1962;Brodsky, Brock-Utne and Samuels, 1979).…”

“…All our patients received morphine or pethidine during the period of study. Endotracheal intubation may cause neck pain and stiffness even when no suxamethonium has been used (Burtles and Tunstall, 1961;Bryson and Ormston, 1962). Duration of surgery and patient position during operation are also factors to be considered.…”

The Incidence and Severity of Muscle Pains After Suxamethonium When Preceded by Gallamine

“…Lamoreaux and Urbach (1960) furthermore found a noticeable decrease in the effect of a single dose of suxamethonium after preliminary tubocurarine. Bryson and Ormston (1962) similarly stressed the difficulties encountered with intubation in a series of patients undergoing Caesarean section in whom gallamine 20 mg was administered prior to suxamethonium 50 mg. These objections are minimized if a much smaller dose of gallamine or tubocurarine is injected, as has been shown in the present series in which no problems of impaired relaxation were encountered.…”