Efficacy of Rocuronium Pretreatment on Succinylcholine-induced Fasciculations and Myalgia: A Randomised Controlled Trial

Introduction: Succinylcholine is a widely used muscle relaxant for its quick onset and short duration of action, however it is associated with fasciculations and myalgia. This may cause discomfort to the patient and can be avoided by using rocuronium as a pretreatment. This effect of rocuronium was evaluated during this study. Aim: To establish the efficacy and safety of using rocuronium as a pretreatment to reduce succinylcholine-induced fasciculations and myalgia. Materials and Methods: This is a double-blinded randomised controlled trial conducted at MM Institute of Medical Science and Research, Mullana, Ambala, Haryana, India between October 2022 and November 2023 and included 40 patients of the American Society of Anaesthesiologists (ASA), physical status I or II, posted for elective surgery under general anaesthesia, divided into two groups of 20 patients each. Group I patients were administered rocuronium 0.06 mg/kg, diluted up to 2 mL, and Group II patients were administered normal saline (2 mL). All patients received propofol induction 2 mg/ kg and succinylcholine 1.5 mg/kg after 30 and 90 seconds of study drug respectively, and the intensity of fasciculations was assessed. Intensity of myalgia was assessed in the immediate postoperative period and after 24 hours. The statistical significance was examined using the Chi Square test. p-value <0.05 was considered statistically significant. Results: Baseline demographic data was comparable among both the groups (mean age in Group I was 42.95 years with 8 females and 12 males while in Group II age was 40.55 years, with 9 females and 11 males). The group that was administered rocuronium had 2 patients with mild fasciculations, 1 patient with mild myalgia and 1 patient with moderate myalgia. Group II had 9 patients with mild fasciculations, 6 with moderate fasciculations, 1 with severe fasciculations, 4 with mild myalgia, 2 with moderate myalgia, 1 with severe myalgia. There was a statistically significant reduction in the incidence and intensity of fasciculations (p-value 0.001). There was also a significantly lesser mean heart rate and mean arterial pressure in the rocuronium group compared to the saline group after intubation at 1 min, 3 min, and 5 min. There was a reduction in postoperative myalgia in the rocuronium group in the immediate postoperative period and after 24 h, but the difference was statistically non significant. Conclusion: Rocuronium pretreatment is safe and effectively reduces succinylcholine-induced fasciculations and provides more stable haemodynamics at a dose of 0.06 mg/kg administered 30 sec before propofol induction. Therefore, rocuronium can be used safely and effectively as a precurarisation drug.