ABSTRACT

Objectives: A comparative study to evaluate effect of pre-operative administration of oral aspirin and precurarization (with pancuronium) in prevention of suxamethonium induced myalgia.

Methodology Design and setting: Tertiary care teaching hospital.

Subjects: The present study was carried out on 75 patients in age group of 16-65 years belonging to ASA grade I or II. The cases undergoing surgery under general anaesthesia where endotracheal intubation was considered desirable and in whom aspirin was not contraindicated.

Resultis: In entire case series of 75 patients, 52 (69.3%) had fasciculation. Out of them Group I patients has least i.e. 24% while group II and Group III had equal i.e 92 % of patients having fasciculation.

Conclusion: Preoperative aspirin 600mg orally 1 hr before operation effectively reduces Suxamethonium induced pain and avoid complications associated with pretreatment with non-depolarising agents.

Keywords: Oral aspirin, Suxamethonium, Fasciculation.

INTRODUCTION

General myalgia after Suxamethonium administration is a frequent and troublesome complication. Suxamethonium is a commonly used short acting depolarizing muscle relaxant. It is a relaxant of choice when there is need for quick muscle relaxation of short duration example in endotracheal intubation, laryngoscopy, orthopedic manipulation .Though an excellent short acting depolarizing muscle relaxant of choice it still has inherent side effects like post operative myalgia, muscular fasciculations, hyperkalemia, increase in intra ocular and intra gastric pressure. Out of them post operative myalgia is the commonly encountered problem of all.

Pain is more in patients who are ambulant within 48 hours of operation. It is noticed that pain commonly affect the neck, shoulders, chest and subcostal region. Inspite of many studies available the mechanism by which post suxamethonium pain is produced has not been established. Rise in lactic acid level in muscle and raised potassium level has been cited as the cause of myalgia. Collier suggested primary event may be the disruption of delicate muscle spindles.

Depending upon the knowledge of generation of post suxamethonium pain attempts have been made to alleviate this pain. These include pretreatment with tubercurarine, gallamine, vecuronium, atracurium, vitamin, a small dose of suxamethonium, lignocaine and propanidid, dantrolene, diazepam(Fahmy et al, and calcium gluconate. The most common of all these is pretreatment with
small dose of non depolarizing muscle relaxant before induction of anaesthesia but this process has difficulty in intubation and increase in dose requirement of suxamethonium.

The recently role of prostaglandin in post operative myalgia led Naquib et al(1986) and Howe etal(1988) to study successfully with prostaglandin inhibitors in prevention of post operative myalgia. They concluded that incidence of myalgia following administration of suxamethonium markedly decreased after administration of oral aspirin which is a non steroidal anti – inflammatory drug and inhibit the synthesis of prostaglandins. It has analgesic and antipyretic action in addition to its antiinflammatory effects. Other advantages being easy oral administration, low cost, easy availability and moreover it does not interfere with intubation.

The present study was carried out to find out the effect of oral aspirin in reducing the incidence of post operative myalgia caused by administration of suxamethonium and to compare it with
precurarization (with pancuronium) and with a control.

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