Preoperative pregabalin prevents succinylcholine-induced fasciculation and myalgia: A meta-analysis of randomized trials

Rev Esp Anestesiol Reanim (Engl Ed). 2024 Apr;71(4):324-331. doi: 10.1016/j.redare.2022.12.002. Epub 2023 Sep 4.

Abstract

Succinylcholine is the gold standard neuromuscular blocker for rapid sequence induction; however, its use is associated with fasciculation and myalgia. We performed a systematic review and meta-analysis of randomized controlled clinical trials comparing gabapentinoids versus placebo for the prevention of fasciculations and succinylcholine-induced myalgias. Six randomized clinical studies were included with a total of 481 patients - 241 in the intervention group and 240 in the placebo group. Gabapentinoids reduced the incidence of succinylcholine-induced myalgia (RR=0.69, 95% CI 0.56-0.84, P<.001), which remained statistically significant for pregabalin (RR=0.71, 95% CI 0.54-0.93, P=.013) and gabapentin (RR=0.61, 95% CI 0.45-0.82, P=.001) separately. There was no difference in fasciculations between the groups (RR=0.92, 95% CI 0.82-1.03, P=.148). Preoperative use of gabapentinoids is associated with lower incidence of succinylcholine-induced myalgias within the first 24h of surgery.

Keywords: Fasciculaciones; Fasciculation; Gabapentin; Gabapentina; Gabapentinoides; Gabapentinoids; Mialgias; Myalgia; Pregabalin; Pregabalina; Succinilcolina; Succinylcholine.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Analgesics / adverse effects
  • Analgesics / therapeutic use
  • Fasciculation* / chemically induced
  • Fasciculation* / prevention & control
  • Gabapentin / therapeutic use
  • Humans
  • Myalgia* / chemically induced
  • Myalgia* / prevention & control
  • Neuromuscular Depolarizing Agents* / adverse effects
  • Pregabalin* / therapeutic use
  • Preoperative Care / methods
  • Randomized Controlled Trials as Topic*
  • Succinylcholine* / adverse effects

Substances

  • Analgesics
  • Gabapentin
  • Neuromuscular Depolarizing Agents
  • Pregabalin
  • Succinylcholine