Succinylcholine-Induced Postoperative Myalgia: Etiology and Prevention

Abstract

Succinylcholine is a neuromuscular blocking agent frequently used to facilitate endotracheal intubation during general anesthesia. It is usually preferred due to its rapid onset of action and short duration of action. However, the effectiveness of this drug is limited by certain adverse effects, one of which is postoperative myalgia. Although generally considered a minor adverse effect, the myalgia may be severe and interfere with return to normal activities of daily life. We present an 18-year-old with a history of ulcerative colitis who presented for anesthetic care during liver biopsy. Due to comorbidities including obesity, succinylcholine was chosen to provide rapid neuromuscular blockade and facilitate endotracheal intubation. Postoperatively, the patient complained of bilateral calf pain. The etiology of muscle pain related to succinylcholine is discussed and potential strategies to reduce its incidence reviewed.

Prevalence and associated factors of postoperative suxamethonium-induced myalgia in surgical patients at Debre Tabor Comprehensive Specialized Hospital Ethiopia: a cross-sectional study

“…The postulated mechanisms for postoperative myalgia include increased intracellular calcium concentrations, membrane phospholipid degradation, and release of free fatty acids and free radicals, which lead to increased membrane permeability. It has been proposed that the pain occurs due to muscle damage produced by shearing forces associated with the fasciculation at the onset of phase one block 32 .…”

“…According to different studies, the prevalence of suxamethonium-induced myalgia varies from 18.1 to 89%, with around 50% being the most frequently reported 6 , 10 , 16 – 18 . The onset and duration of the discomfort is variable across different patients.…”

The Antioxidant Effect of Selenium on Succinylcholine-related Myalgia After Adult Sinuscopies: Randomized Controlled Double-Blind Trial

“…The adverse effects related to succinylcholine, such as life-threatening hyperkalemia, are more common in the presence of certain comorbidities and thus preclude its use in such situations. In general, succinylcholine use is mostly limited to a suspected difficult airway or when a rapid safe airway is recommended (14).…”

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

“…Similarly, muscle pain can be explained by the continuous skeletal muscle deformations caused by the bodyweight forces; however, in the case of muscle tissue, this is combined with spikes of dynamic intra-muscular shearing forces because of fasciculations that are generated by the drug. 38 The intensity and distribution of muscle tissue loads generated by these complex biomechanical interactions depends on the individual anatomy, body habitus, and soft tissue composition and also on the severity of the fasciculations caused by succinylcholine. The multifactorial contributions to the muscle tissue loading state explain the aforementioned variable incidence of myalgia across patients.…”