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EFFECT OF INTRAVENOUS LIGNOCAINE AND NORMAL SALINE PLACEBO IN PREVENTING SUXAMETHONIUM – INDUCED FASCICULATION AND POST-OPERATIVE MYALGIA IN SURGICAL PATIENTS
Abstract
Background:
Suxamethonium (succinylcholine) is currently the only widely used depolarising agent. It is
the agent of choice for rapid sequence induction due to its rapid onset of action, short
duration and excellent muscle relaxation. However, fasciculation which is a side effect of
suxamethonium, is undesirable for most patients due to the body pains experienced after
surgery.
The use of 1% lignocaine (6mls) and thiopentone sodium (4mg/kg) was compared with
intravenous normal saline (placebo) (6mls) and thiopentone sodium (4mg/kg) to assess if
intravenous lignocaine will mitigate the occurrence of fasciculations and subsequently
prevent post-operative myalgia.
Methodology:
This study is a double blinded, prospective, randomised, placebo-controlled trial in adult
surgical patients. One hundred and fifty two patients were drawn from ASA I or II patients,
aged between 18 and 45 years and scheduled for elective surgery in the University of Benin
Teaching Hospital.
Following informed consent, the patients were randomized to receive thiopentone(4mg/kg)
and normal saline (6mls)(Group I) or thiopentone(4mg/kg) and 1% lignocaine (60mg) (6mls)
(Group II). They were all pre – medicated with oral diazepam 10mg at night and 6am on the
morning of surgery. The preoperative vital signs including pulse rate, blood pressure, mean
arterial pressure and oxygen saturation were recorded.
The fasciculation score, pulse rate, blood pressure, mean arterial pressure and oxygen
saturation at various time intervalswere noted and documented. The duration of muscle
fasciculationsat various time intervals (in seconds) was also noted and documented for all the
patients.
Results:
One hundred and fifty two ASA I and II patients, 61(40.1%) males and 91(59.9%) females
aged between 18 and 45 years participated in this study. There was no statistically significant
difference between the groups with regards to age (p = 0.194), weight (p = 0.087), and
between BMI and presence of muscle fasciculations (p = 0.148), in the respondents.
There was a statistically significant difference between the groups with regards toheight (p =
0.010) and body mass index (BMI) (p = < 0.001).
Fasciculations were absent in 17 (22.4%) respondents and present in 59 (77.6%) respondents
in Group II. All 76 (100%) patients in Group I had fasciculations in response to
suxamethonium. Fasciculations were commoner in males (96.7%) than in females (83.5%).
Postoperative myalgia occurred more in Group I (6.6%) than in Group II (3.9%) and was
found to be commoner in males.
Conclusion:
The study provides data that suggest that muscle fasciculations associated with the use of
suxamethonium for tracheal intubation is reduced with the use of 60mg of 1% intravenous
lignocaine. This is important as patients who were administered 60mg of 1% intravenous
lignocaine prior tointravenoussodium thiopentone and suxamethoniumadministration will be
spared the undesirable side effects of suxamethonium(fasciculations).
